title: Nonventilatory strategies to prevent postoperative pulmonary complications.
abstract: OBJECTIVE
  In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery.
  
  
  RESULTS
  Although nonavoidable, most comorbidities can be modified in order to reduce the incidence of pulmonary events postoperatively. The physical status of patients suffering from chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, and congestive heart failure can be improved preoperatively, and a number of measures can be undertaken to prevent PPCs, including physiotherapy for pulmonary rehabilitation and drug therapies. Also, smokers may benefit from both short and long-term smoke cessation. Furthermore, the risk of PPCs may be reduced upon: choice of an adequate anesthesia strategy (e.g. regional vs. general); appropriate neuromuscular blockade and reversal; use of volatile instead of intravenous anesthetics in lung surgery; judicious intravascular volume expansion (restrictive vs. liberal strategy); regional instead of systemic analgesia after major surgery in high-risk patients; more strict indication for nasogastric decompression in order to avoid silent aspiration; and laparoscopic instead of open bariatric surgery.
  
  
  CONCLUSIONS
  Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
authors: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden, TU Dresden, Dresden, Germany.
authors: Andreas
authors: A
authors: Güldner
authors: Paolo
authors: P
authors: Pelosi
authors: Marcelo Gama
authors: MG
authors: de Abreu
mesh_terms: D000768:Anesthesia, General; D005440:Fluid Therapy; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008171:Lung Diseases / Q000517:prevention & control*; D019148:Neuromuscular Blockade; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000517:prevention & control