Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000100014
Brazilian Journal of Anesthesiology
Review Article

Avaliação pré-operatória do pneumopata

Preoperative assessment of lung disease patients

Gilson Ramos; José Ramos Filho; Edísio Pereira; Marcos Junqueira; Carlos Henrique C. Assis

http://dx.doi.org/10.1590/S0034-70942003000100014 Braz J Anesthesiol, vol.53, n1, p.114-126, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: As complicações pulmonares são as causas mais freqüentes de morbimortalidade pós-operatória, especialmente nos pneumopatas. Por essa razão, esses pacientes devem ser criteriosamente avaliados e preparados no pré-operatório, tanto do ponto de vista clínico como laboratorial. O objetivo da presente revisão é determinar o risco cirúrgico e estabelecer condutas pré-operatórias para minimizar a morbimortalidade per e pós-operatórias, nos portadores de doenças respiratórias. CONTEÚDO: As principais repercussões do ato anestésico-cirúrgico na função pulmonar foram relatadas. Da mesma forma, procurou-se selecionar os pacientes de maior risco, envolvidos ou não em ressecção pulmonar. Para esse fim, utilizou-se da propedêutica clínica e laboratorial. Finalmente, foi apresentada uma proposta de algoritmo pré-operatório para os procedimentos com ressecção pulmonar. CONCLUSÕES: O portador de doença respiratória, especialmente as de evolução crônica, necessita ser rigorosamente avaliado no pré-operatório. A classificação do estado físico (ASA) e o índice de Goldman são fatores de previsão de risco importantes nos pneumopatas não-candidatos à ressecção pulmonar. Somando-se a esses critérios, nos candidatos à ressecção pulmonar, o VO2 max, o VEF1e capacidade de difusão estimados para o pós-operatório, são imprescindíveis, em algumas situações. Os beta2-agonistas e corticóides devem ser considerados nos pré-operatórios desses pacientes.

Palavras-chave

AVALIAÇÃO PRÉ-OPERATÓRIA, DOENÇA

Abstract

BACKGROUND AND OBJECTIVES: Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. CONTENTS: Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. CONCLUSIONS: Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldman’s cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

Keywords

PREOPERATIVE EVALUATION, DISEASE

Referencias

Aboussouan LS, Stoller JK. Perioperative Pulmonary Care. Rehabilitation of Patient with Respiratory Disease. 1999:561-575.

Faresin SM, Medeiros RA. Avaliação Pré-Operatória. Atualização Terapêutica. 2001:1297-1301.

Stoelting RK, Dierdorf SF, McCammon RL. Obstructive Airways Disease and Restrictive Pulmonary Disease. Anesthesia and Co-existing Disease. 1988:195-233.

Sykes LA, Bower EA. Cardiorespiratory effects of anesthesia. Clin Chest Med. 1993;14:211-226.

Wiener-Kronish JP, Matthay MA. Preoperative Evaluation. Textbook of Respiratory Medicine. 1988:683-698.

Pizov R, Takahashi M, Hirshman CA. Halothane inhibition of ion transport of the tracheal epithelium: A possible mechanism for anesthetic-induced impairment of mucociliary clearance. Anesthesiology. 1992;76:985-989.

Craig DB. Postoperative recovery of pulmonary function. Anesth Analg. 1981;60:46-52.

Ali J, Weisel RD, Layug AB. Consequences of postoperative alterations in respiratory mechanics. Am J Surg. 1974;128.

Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth. 1987;59:1230-1235.

Peruzzi WT. Evaluation, Preparation, and Management of the Patient with Respiratory Disease. ASA Refresher Courses in Anesthesiology. 1998;26:137-151.

Kingston HGG, Hirshman CA. Perioperative management of the patient with asthma. Anesth Analg. 1984;63:844-855.

Torrington KG, Henderson CJ. Perioperative respiratory therapy (PORT): A program of preoperative risk assessment and individualized postoperative care. Chest. 1988;93:946-951.

Position paper: preoperative pulmonary function testing. Ann Intern Med. 1990;112:793-794.

Kroenk K, Lawrence VA, Theroux JF. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med. 1992;152:967-971.

Kroenk K, Lawrence VA, Theroux JF. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest. 1993;104:1445-1451.

Wong DH, Weber EC, Schell MJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 1995;80:276-284.

Lawrence VA, Dhanda R, Hilsenbeck SG. Risk of pulmonary complications after elective abdominal surgery. Chest. 1996;110:744-750.

Jayr C, Matthay MA, Goldstone J. Preoperative and intraoperative factors associated with prolonged mechanical ventilation: a study in patients following major abdominal vascular surgery. Chest. 1993;103:1231-1236.

Goldman L, Calderal DL, Nussbaum SR. Multifactorial index risk in noncardiac surgical procedures. N Engl J Med. 1977;297(20):845-850.

Charlson ME, Pompei P, Ales KL. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.

Hall JC, Tarala RA, Hall LJ. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99:923-927.

Calligaro KD, Azurin DJ, Dougherty MJ. Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg. 1993;18:914-921.

Williams-Russo P, Charlson ME, MacKenzie R. Predicting postoperative pulmonary complications: is it a real problem?. Arch Intern Med. 1992;152:1209-1213.

Macpherson DS. Pulmonary function tests before surgery. Chest. 1996;110:587-589.

Olsen GN, Block AJ, Swenson EW. Pulmonary function evaluation of the lung resection candidate: A prospective study. Am Rev Respir Dis. 1975;111:379-387.

Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg. 1995;109:275-283.

Boushy SF, Billig DM, North LB. Clinical course related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma. Chest. 1971;59:383-391.

Boysen PG, Block AJ, Moulder PV. Relationship between preoperative pulmonary function tests and complications after thoracotomy. Surg Gynecol Obstetr. 1981;152:813-815.

Marshall MC, Olsen GN. The physiologic evaluation of the lung resection candidate. Clin Chest Med. 1993;14:305-320.

Kearney DJ, Lee TH, Reilly JJ. Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function. Chest. 1994;105:753-759.

Markos J, Mullan BP, Hillman DR. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis. 1989;139:902-910.

Gass GD, Olsen GN. Preoperative pulmonary function testing to predict postoperative morbidity and mortality. Chest. 1986;89:127-135.

Juhl B, Frost N. A comparison between measured and calculated changes in the lung function after operation for pulmonary cancer. Acta Anaesthesiol Scand. 1975;57:39-45.

Ratto OR. Pneumologia. Clínica Médica: Propedêutica e Fisiopatologia. 1984:219-279.

Fergunson MK, Little L, Rizzo L. Diffusion capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg. 1988;96:894-900.

Pierce RJ, Copland JM, Sharpe K. Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. Am J Respir Crit Care Med. 1994;150:947-955.

Bolliger CT, Jordan P, Soler M. Exercise capacity as a predictor of postoperative complications in lung resection candidates. Am J Respir Crit Care Med. 1995;151:1472-1480.

Morice RC, Peters EJ, Ryan MB. Exercise testing in the evaluation of patients at high risk for complications from lung resection. Chest. 1992;101:356-361.

Ali Mk, Mountain CF, Ewer MC. Predicting loss of pulmonary function after pulmonary resection for bronchogenic carcinoma. Chest. 1980;77:337-342.

Olsen GN, Block AJ, Tobias JA. Prediction of postpneumonectomy pulmonary function using quantitative macroaggregate lung scanning. Chest. 1974;66:13-16.

Holden DA, Rice TW, Stelmach K. Exercise climbing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection. Chest. 1992;102:1774-1779.

Gibbons , Balady GJ, Beasley JW. AACC / AHA Guidelines for exercise testing: A report of the American College of Cardiology / American Heart Association task force on practice guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997;30:260-311.

Gracey DR, Divertie MB, Didier EP. Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study. Chest. 1979;76:123-129.

Svensson LG, Hess KR, Coselli JS. A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg. 1991;14:271-282.

Warner MA, Divertie MB, Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. Anesthesiology. 1984;60:380-383.

Kumeta Y, Hattori A, Mimura M. A survey of perioperative bronchospasm in 105 patients with reactive airway disease. Masui. 1995;44:396-401.

Stoller JK, Gerbarg ZB, Feinstein AR. Corticosteroids in stable chronic obstructive pulmonary disease: Reappraisal of efficacy. J Gen Intern Med. 1987;2:29-35.

Dunlap NE, Fulmer JD. Corticosteroid therapy in asthma. Clin Chest Med. 1984;5:669-683.

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