Perioperative management of the patient with respiratory disease

Cardiorespiratory disease is the commonest cause of perioperative morbidity and mortality in the western world. Each year in the UK, around 25,000 to 30,000 patients die within 30 days of surgery. The most important pulmonary complications are exacerbation of existing respiratory disease, pneumonia and respiratory failure. The key to reducing problems in this group of patients is identification of those individuals most at risk and optimization of medical management. A perioperative care plan can then be instituted for each individual patient in order to gain maximum benefit from available therapeutic interventions. While complications can never be totally prevented, a worsening of vital signs generally precedes impending critical illness. Prompt recognition of any physiological deterioration and early intervention are the key to avoiding a poor outcome in such circumstances. Early warning scoring (EWS) systems have been implemented in many postoperative care areas to draw attention to any deterioration in vital signs at an early stage. This article focuses on the perioperative management of patients with respiratory disease.