Preventing Perioperative Pulmonary Complications in the Elderly

Abstract

Perioperative pulmonary complications are serious complications associated with an approximately 10-fold increase in perioperative deaths, making their prevention a crucial issue in perioperative medicine. Aging is associated with physiological changes in the respiratory system such as airway defense, respiratory muscle strength, and ventilatory response, which predispose patients to pulmonary problems. In fact, advanced age is an independent risk factor for perioperative pulmonary complications, and major surgery performed on elderly patients should be regarded as posing a high risk of pulmonary complications. Recently, several strategies for preventing perioperative pulmonary complications have been reported, and meta-analyses have demonstrated the effectiveness of certain interventions. Complete antagonism of muscle relaxants, lung protective ventilation, and application of enhanced recovery after surgery pathway are critical steps to prevent perioperative pulmonary complications and should be implemented in all surgical cases. Respiratory physiotherapy, epidural anesthesia, and goal-directed hemodynamic therapy have proved effective in the prevention of perioperative pulmonary complications. It is essential to use these strategies based on patient risk and planned surgical procedures.