Postoperative pulmonary complications: pneumonia and acute respiratory failure

Postoperative pulmonary complications (atelectasis, pneumonia, pulmonary edema, acute respiratory failure) are common, particularly after abdominal and thoracic surgery, pneumonia and atelectasis being the most common. Postoperative pneumonia is associated with increased morbidity, length of hospital stay, and costs. Few institutions have pneumonia prevention programs for surgical patients, and these should be strongly considered. Acute respiratory failure is a life-threatening pulmonary complication that requires institution of mechanical ventilation and admission to the intensive care unit, and is associated with increased risk for ventilator-associated pneumonia. This article discusses epidemiology, risk factors, diagnosis, treatment, and prevention of these pulmonary complications in surgical patients.     

Postoperative respiratory failure resulting from perioperative withdrawal of antiparkinsonian medications

A patient with Parkinson's disease developed postoperative respiratory arrest due to perioperative withdrawal of antiparkinsonian medications and later presented a rapid recovery after parenteral administration of levodopa. In perioperative management of parkinsonian patients, it is important to continue antiparkinsonian medications until the operation is started and to administer levodopa parenteraly after the operation until oral administration of antiparkinsonian drugs becomes possible. In addition, we must pay attention to the choice of drugs so that parkinsonism may not be induced or aggravated.     

Postoperative respiratory failure caused by acute exacerbation of idiopathic interstitial pneumonia

We herein report a case of postoperative respiratory failure caused by acute exacerbation of undiagnosed interstitial pneumonia (IP). A 76-year-old woman underwent two subsequent operations, cholecystectomy and resection of lipoma in the neck, under general anesthesia at an interval of 12 days. Although the postoperative course of the first operation was uneventful, the patient abruptly developed respiratory failure on the 4th postoperative day (POD) of the second operation. Although steroid therapy was transiently effective to improve oxygenation, respiratory failure was gradually deteriorated. She died on the 25th POD. She had a past history of right upper lobectomy for pseudotumor resulting from cryptogenic organizing pneumonia in another hospital 4 years ago. The follow-up CT performed in this hospital demonstrated subtle foci of ground-glass opacities in the left lung; however, no diagnosis of IP had been made. Thus, we concluded that idiopathic IP had gradually advanced preoperatively, and acute exacerbation was triggered by perioperative stress. The present case warned us that acute exacerbation of IP could occur in a patient with mild symptoms. Therefore, preoperative proper diagnosis is thought to be important as acute exacerbation of IP is a highly morbid clinical event.     

低肺功能肺癌病人术后呼吸衰竭原因分析

目的　回顾性分析总结 181例手术治疗的低肺功能肺癌病人中 2 3例发生呼吸衰竭的原因和治疗经验。方法　应用SPSS统计软件中的二项分类Logistic回归分析及卡方检验 ( χ2 )进行统计分析和比较。结果　切除组 177例低肺功能病人中发生呼吸衰竭 2 3例 ( 13 0 %)。术后因严重肺部感染而发生呼吸衰竭 18例 ( 78 3 %)。因呼吸衰竭所致死亡 12例 ,住院死亡率为 5 2 2 %( 12 2 3例 )。经二项分类Logistic回归分析发现 ,术后呼吸衰竭发生与否依次与术后并发症多少、肺功能障碍程度、手术切除范围、术前是否使用抗生素、术前有无开胸手术史等高度相关。其危险系数 (OR)依次分别为 :11 2 3、2 79、2 41、2 0 5、1 80。其中前 3项影响最显著 (P <0 0 5 )。结论　低肺功能肺癌病人发生术后呼吸衰竭的高危因素有术后并发症多少、肺功能障碍程度、手术切除范围和术前开胸手术史及心肺病史。呼吸道感染是术后诱发呼吸衰竭的主要原因。