Perioperative respiratory management in high risk patients

Mechanical ventilation during surgery was thought to be easy, because it is only of short duration, and it is used for paralyzed, healthy lungs. Recently, however, it is reported that high risk patients are increasing in number and the actual incidence of postoperative pulmonary complications (PPC) is as high as 20-30%. Nowadays, we should pay more attentions to perioperative respiratory care especially in high risk patients. In preoperative periods, several risk calculation systems has been already reported, but their validation and routine use are still limited We really have to pay more attention in predicting high risk patients for PPC. During general anesthesia, lung protective ventilation could be applied especially in high risk patients, and it could reduce PPC. After surgery, high flow nasal cannula can be used to prevent re-intubation, but it is not known whether this approach could reduce PPC. Of course, more evidence is needed, but we suggest that anesthesiologists should pay more attention not only to maintenance of anesthesia during surgery, but also to prevention of PPC by perioperative respiratory care.