Preoperative evaluation of the respiratory system: A narrative review based on Hellenic Thoracic Society guidelines

Abstract

Preoperative evaluation prior to thoracic surgery aims to assess the risk associated with the planned surgical intervention and thus to aid the selection of the appropriate plan of anaesthesia and of perioperative care that will provide optimal patient safety. Risk factors for the occurrence of perioperative and postoperative complications can be classified as patient-related and procedure-related. Among others, they include age, increased body weight, the presence of comorbidities such as chronic respiratory diseases, smoking history, site of surgery, duration of anaesthesia, and the type of anaesthesia. The preoperative evaluation is predominantly based on obtaining a detailed medical history and performance of a comprehensive physical examination. Preoperative chest radiograph and exercise testing are indicated in some highrisk patient groups, while assessment of oxygenation, pulmonary function, and laboratory parameters (such as albumin, urea nitrogen, and haemoglobin) are important factors for determining the risk of postoperative respiratory complications for all patients. This article outlines disease-specific evaluation and management practices for patients with chronic obstructive pulmonary disease, asthma, obstructive sleep apnoea, pulmonary hypertension, right-sided heart failure, lung cancer and interstitial lung disease that are about to undergo thoracic surgery.

Keywords

• lung cancer
• interstitial lung disease
• pulmonary hypertension
• chronic obstructive pulmonary disease
• preoperative evaluation
• sleep-disordered breathing