Preoperative evaluation and perioperative management of patients with pulmonary disease.

Numerous studies in recent years have documented the increased risk of perioperative complications in patients with pulmonary disease. In assessing lung function before anesthesia and surgery, history and physical examination may be helpful but spirometry and blood gas determination are more accurate indicators of significant pulmonary disease. Risk apparently can be minimized by intensive chest therapy before and after surgery. Low-dose heparin therapy, in particular, is rec-mmended to prevent deep venous thrombosis and pulmonary embolism.