• Nicolino Ambrosino and Luciano Gabbrielli.
• Respiratory Unit, Cardio-Thoracic Department, University Hospital, Pisa, Italy. n.ambrosino@ao-pisa.toscana.it
• Best Pract Res Clin Anaesthesiol. 2010 Jun 1; 24 (2): 283-9.

AbstractSurgery and general anaesthesia have direct effects on the respiratory system depending on the organ/system involved and modality of delivery, potentially leading to postoperative pulmonary complications that increase hospital morbidity, prolong hospital stay and add to health-care costs. Postoperative complications have been reported to be as high as 30% for thoracotomy and lung resection in patients with chronic obstructive pulmonary disease. Most of the complications are due to respiratory muscle dysfunction and surgery-related changes in chest wall mechanics. In general, preoperative optimisation of medical therapy combined with physiotherapy and early extubation and mobilisation may improve clinical outcomes in high-risk surgeries, including upper abdominal and thoracic surgery in patients with severe emphysema. Evidence from randomised controlled trials or meta-analyses is limited and most of the recommendations on perioperative physiotherapy come from either uncontrolled or non-randomised trials or from observational studies and expert opinion.

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