3. JACKSON EQUESTRIAN MONUMENT
downtown Charlottesville,Virginia “Stonewall” Jackson
Confederate General
…dying of pneumonia 10 days after
an otherwise successful ether anesthetic
1863
18. The most important risk factor for
postoperative pulmonary
complications?
A. High-risk surgical site B. General anesthesia
C. COPD D. Obesity
19. Patient-related
Advanced age
ASA PS >2
Cong Heart failure
Functional dependency
COPD
Surgery-related
Aortic aneurysm repair
Thoracic surgery
Abdominal surgery
Upper abdominal surgery
Neurosurgery
Prolonged surgery
Head & Neck surgery
Emergency surgery
Vascular surgery
Use of GeneralAnesthesia
23. Which of the following is a recently
identified novel risk factor for PPCs?
C. Pulmonary
Hypertension
B. Insulin-treated diabetesA. Epidural anesthesia
D. Immobility
26. Selective postop NG tube use
NG tubes potentially increase risk of aspiration
Use in select patients:
• Symptomatic abdominal distention
• Inability to tolerate oral intake
• Nausea
27. Laparoscopic (vs Open) operation
Evidence begins to follow intuition
Open surgery:
• Higher rate of sepsis
• CV events
28. RoutineTPN or enteral nutrition
Right heart catheterization
While hypoalbuminemia and malnutrition
increase postoperative complications,
including pneumonia, routineTPN has no
benefit over eitherTEN or no
hyperalimentation.
Inadequate intake
Atrophy of intestinal villi
Bacterial translocation across
gut mucosa
Subsequent sepsis
29. Intraop neuraxial blockade
Postop epidural analgesia
Insufficient or conflicting data
? Selection bias
? Insufficiently powered study
- Study on low-risk procedure
37. Surgical site
Most important predictor of
risk of PPCs:
Aortic, thoracic and upper
abdominal surgeries are high-
risk procedures, even in
healthy patients
38. OSA & Pulmonary HTN
Recently identified as risk
factors;
Limited available evidence
does not support preop
screening (in patients without
symptoms)
39. Postop CPAP
Effective for reducing
pulmonary complications in
patients who are unable to
perform deep breathing or
incentive spirometry
exercises