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Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery
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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: closed (25 June 2024) | Viewed by 9820

Special Issue Editor

Prof. Dr. Roop Kaw

E-Mail Website
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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

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Published Papers (4 papers)

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Review

12 pages, 257 KiB  
Review
Evaluation and Prevention of Perioperative Respiratory Failure
by Jacqueline Palermo, Spencer Tingey, Ashish K. Khanna and Scott Segal
J. Clin. Med. 2024, 13(17), 5083; https://doi.org/10.3390/jcm13175083 - 27 Aug 2024
Viewed by 2583
Abstract
Respiratory failure is a common perioperative complication. The risk of respiratory failure can be reduced with effective preoperative evaluation, preventative measures, and knowledge of evidence-based management techniques. Effective preoperative screening methods include ARISCAT scoring, OSA screening, and the LAS VEGAS score (including the [...] Read more.
Respiratory failure is a common perioperative complication. The risk of respiratory failure can be reduced with effective preoperative evaluation, preventative measures, and knowledge of evidence-based management techniques. Effective preoperative screening methods include ARISCAT scoring, OSA screening, and the LAS VEGAS score (including the ASA physical status score). Evaluation by the six-minute walk test and a routine pulmonary physical exam has been shown to be effective at predicting postoperative pulmonary complications, whereas evidence on the predictive power of pulmonary function tests and chest radiography has been inconclusive. Preoperative smoking cessation and lung expansion maneuvers have been shown to decrease the risk of pulmonary complications postoperatively. Intraoperative management techniques that decrease the pulmonary complication risk include neuromuscular blockade reversal with sugammadex, limiting surgical times to less than 3 h when possible, lung-protective ventilation techniques, and multimodal analgesia to decrease opioid usage. In the immediate postoperative period, providers should be prepared to quickly treat bronchospasm, hypoventilation, and upper airway obstruction. For post-surgical patients who remain in the hospital, the risk of pulmonary complications can be decreased with lung expansion techniques, adequate analgesia, automated continuous postoperative ward monitoring, non-invasive ventilatory support, and early mobilization. This article was written to analyze the available literature on this topic in order to learn and practice the prevention of perioperative respiratory failure when caring for patients on a daily basis. Full article
(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)
13 pages, 740 KiB  
Review
Screening and Perioperative Management of Obesity Hypoventilation Syndrome
by Roop Kaw, Kara Dupuy-McCauley and Jean Wong
J. Clin. Med. 2024, 13(17), 5000; https://doi.org/10.3390/jcm13175000 - 23 Aug 2024
Viewed by 1560
Abstract
Obesity hypoventilation syndrome (OHS) can often be underdiagnosed or misdiagnosed and has been shown to pose significant risks in perioperative situations. Patients with OHS have a higher prevalence of baseline morbid conditions like hypertension, congestive heart failure (CHF), diabetes mellitus, atrial fibrillation, and [...] Read more.
Obesity hypoventilation syndrome (OHS) can often be underdiagnosed or misdiagnosed and has been shown to pose significant risks in perioperative situations. Patients with OHS have a higher prevalence of baseline morbid conditions like hypertension, congestive heart failure (CHF), diabetes mellitus, atrial fibrillation, and pulmonary hypertension (PH), which contribute to adverse postoperative outcomes. The potential challenges include difficult intubation and loss of airway, postoperative respiratory failure, worsening heart failure, pulmonary hypertensive crisis, and opioid-induced respiratory depression (OIRD). It is, therefore, important to screen all obese patients for obstructive sleep apnea (OSA) and OHS before elective surgical procedures. The aim of this review is to discuss the preoperative screening and evaluation and safe anesthetic and up-to-date ventilatory management of this complex group of patients. This review also intends to increase the awareness of OHS in the adult population among hospitalists, surgeons, and cardiologists who may find themselves taking care of these patients in complex multidisciplinary settings. Full article
(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)
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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 1884
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
(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)
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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
Cited by 3 | Viewed by 3077
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
(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)
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