Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 25 June 2024 | Viewed by 1563

Special Issue Editor


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Guest Editor
Departments of Hospital Medicine & Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
Interests: perioperative medicine; obstructive sleep apnea (OSA); obesity hypoventilation; pulmonary hypertension; postoperative respiratory failure

Special Issue Information

Dear Colleagues,

The area of preoperative evaluation and perioperative management in patients with respiratory disease and for those at risk for respiratory complications is rapidly evolving. Lots of new literature has emerged over the last decade or two with the addition of some disease-specific guidelines and position papers. These include recommendations on the anesthetic management of OSA, obesity hypoventilation syndrome and pulmonary hypertension. These conditions may oftentimes come to the surface for the first time during a preoperative evaluation and when unrecognized can impact the postoperative course. Similarly, neuromuscular disease has major implications perioperatively and this area is also evolving in regards to airway management. Finally, whether or not to monitor postoperative patients on non-ICU floors for respiratory complications is an area of intense debate and controversy and is in need of high-quality research. In this Special Issue, we invite papers from authors and investigators who have spent considerable time studying these issues as well as those who have provided clinical experience and consensus.

Prof. Dr. Roop Kaw
Guest Editor

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Keywords

  • perioperative medicine
  • obstructive sleep apnea (OSA)
  • obesity hypoventilation
  • pulmonary hypertension
  • postoperative respiratory failure

Published Papers (2 papers)

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Review

15 pages, 443 KiB  
Review
Perioperative Management in Neuromuscular Diseases: A Narrative Review
by Aparna Bhat, Jason Dean and Loutfi S. Aboussouan
J. Clin. Med. 2024, 13(10), 2963; https://doi.org/10.3390/jcm13102963 - 17 May 2024
Viewed by 547
Abstract
Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to [...] Read more.
Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome. Full article
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16 pages, 1193 KiB  
Review
Obstructive Sleep Apnea and Risk of Postoperative Complications after Non-Cardiac Surgery
by Rabail Arif Chaudhry, Lori Zarmer, Kelly West and Frances Chung
J. Clin. Med. 2024, 13(9), 2538; https://doi.org/10.3390/jcm13092538 - 26 Apr 2024
Viewed by 591
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative [...] Read more.
Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative screening has become essential in many institutions to identify patients at increased risk, and experts recommend proceeding with surgery in the absence of severe symptoms, albeit with heightened postoperative monitoring. Anesthetic and sedative agents exacerbate upper airway collapsibility and depress central respiratory activity, complicating intraoperative management, especially with neuromuscular blockade use. Additionally, OSA patients are particularly prone to opioid-induced respiratory depression, given their increased sensitivity to opioids and heightened pain perception. Thus, regional anesthesia and multimodal analgesia are strongly advocated to reduce perioperative complication risks. Postoperative care for OSA patients necessitates vigilant monitoring and tailored management strategies, such as supplemental oxygen and Positive Airway Pressure therapy, to minimize cardiorespiratory complications. Health care institutions are increasingly focusing on enhanced monitoring and resource allocation for patient safety. However, the rising prevalence of OSA, heterogeneity in disease severity, and lack of evidence for the efficacy of costly perioperative measures pose challenges. The development of effective screening and monitoring algorithms, alongside reliable risk predictors, is crucial for identifying OSA patients needing extended postoperative care. This review emphasizes a multidimensional approach in managing OSA patients throughout the perioperative period, aiming to optimize patient outcomes and minimize adverse outcomes. Full article
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