title: Physiotherapy in the perioperative period.
abstract: Surgery and general anaesthesia have direct effects on the respiratory system depending on the organ/system involved and modality of delivery, potentially leading to postoperative pulmonary complications that increase hospital morbidity, prolong hospital stay and add to health-care costs. Postoperative complications have been reported to be as high as 30% for thoracotomy and lung resection in patients with chronic obstructive pulmonary disease. Most of the complications are due to respiratory muscle dysfunction and surgery-related changes in chest wall mechanics. In general, preoperative optimisation of medical therapy combined with physiotherapy and early extubation and mobilisation may improve clinical outcomes in high-risk surgeries, including upper abdominal and thoracic surgery in patients with severe emphysema. Evidence from randomised controlled trials or meta-analyses is limited and most of the recommendations on perioperative physiotherapy come from either uncontrolled or non-randomised trials or from observational studies and expert opinion.
authors.affiliation: Respiratory Unit, Cardio-Thoracic Department, University Hospital, Pisa, Italy. n.ambrosino@ao-pisa.toscana.it
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ambrosino
authors.forename: Luciano
authors.initials: L
authors.lastname: Gabbrielli
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D015656:Respiratory Mechanics