[The patient with respiratory problems].

Abstract

Despite improvements in operative and anesthesiological techniques, respiratory problems in surgical patients have been minimized but not eliminated. In addition to risks which are typical for the individual patient, the perioperative respiratory morbidity is affected by anesthesiological manipulations as well as the operation and the nature of the operation (elective versus emergency). In this paper, after describing anesthesia-associated disturbances of the respiratory situation together with worsening due to the disease in patients with COLD, techniques and methods for therapy, prophylaxis, and prognostic assessment are delineated. Two examples are given for patients with respiratory problems (abdomino-thoracic esophageal resection as a example of local trauma in patients with numerous preoperative risk factors and acute necrotizing pancreatitis to describe the sequelae of a toxic process). The essence of our discussion is that, prognostically, preoperative diagnosis is of reduced value. Only a synopsis of clinical findings together with spirometry and blood gas analysis appears to be relevant. Early mobilization in conjunction with excellent postoperative pain therapy is of utmost importance, which is equivalent to the almost routine placement of a patient controllable epidural analgesia technique. These concepts have shown in the two patient groups described that respiratory morbidity may be reduced significantly. Cooperation between surgeons and anesthesiologists, which is characterized by complete and mutually high competence on both sides, is essential for successfully managing patients at increased respiratory risk.