title: Pre-operative optimisation of lung function.
abstract: The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4-6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function.
authors.affiliation: Department of Anaesthesiology, Stanley Medical College and Government RSRM Hospital, Chennai, Tamil Nadu, India.
authors.forename: Naheed
authors.initials: N
authors.lastname: Azhar
keywords: Asthma; beta 2 agonists; chronic obstructive pulmonary disease; incentive spirometry; inhaled steroids; post-operative pulmonary complications; smoking