Preanesthetic Assessment for Thoracic Surgery

All patients having pulmonary resections should have a • preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function, and cardiopulmonary reserve (the “three-legged stool” of respiratory assessment). Following pulmonary resection surgery, it is usually possible • to wean and extubate patients with adequate predicted postoperative respiratory function in the operating room provided they are “AWaC” (alert, warm and comfortable). Preoperative investigation and therapy of patients with • coronary artery disease for noncardiac thoracic surgery is becoming a complex issue. An individualized strategy in consultation with the surgeon, cardiologist, and patient is required. Myocardial perfusion, CT coronary angiography, and other advances in imaging are used increasingly in these patients. Geriatric patients are at a high risk for cardiac complica• tions, particularly arrhythmias, following large pulmonary resections. Preoperative exercise capacity is the best predictor of post-thoracotomy outcome in the elderly. In the assessment of patients with malignancies, the “four • M’s” associated with cancer must be considered: mass effects, metabolic effects, metastases, and medications. Perioperative interventions which have been shown to • decrease the incidence of respiratory complications in highrisk patients undergoing thoracic surgery include: cessation of smoking, physiotherapy, and thoracic epidural analgesia.