(1)   Which of the following patients have the maximum risk of postoperative pulmonary complications?

 (a)    A 55 years old woman undergoing open cholecystectomy for chronic calculous cholecystitis.

(b)   A 60 years old smoker undergoing Coronary artery bypass grafting

(c)    A 45 years old healthy man undergoing liposuction of his abdominal fat

(d)   A 66 years old smoker who is undergoing esophago-gastric resection and esophago-jejunostomy for cancer of the middle third of esophagus.

 Answer: The answer is (d). This man is undergoing a major surgery involving the thorax and the abdomen. He is also scheduled for a general anesthesia and is a smoker. All these factors predispose him to a high risk of postoperative pulmonary complications. The others are relatively lower risk due to the nature of their surgery and the other comorbid conditions.

(1)   In the above case of high risk for post operative pulmonary complications all the following would be interventions to reduce the risk except.

 (a)    Use of incentive spirometry

(b)   Use of long term, high dose, broad spectrum antibiotics

(c)    Continuous positive airway pressure

(d)   Post operative epidural analgesia

 Answer: The answer is (b). It has been shown that use of incentive spirometry consistently reduces the risk of postoperative pulmonary complications by 50%. Those patients who are not able to perform incentive spirometry and deep breathing exercises should be maintained on continuous positive airway pressure. The use of postoperative epidural analgesia has been shown to reduce major pulmonary complications postoperatively in case of major abdomino-thoracic surgeries like the one mentioned above.