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Communications to the Editor |

Preoperative Pulmonary Consultation at a University HospitalPreoperative Pulmonary Consultation at a University Hospital FREE TO VIEW

Adil Zamani, MD
Author and Funding Information

Affiliations: Selçuk University Hospital, Konya, Turkey,  St. Francis Hospital and Medical Center, Hartford, CT

Correspondence to: Adil Zamani, MD, Nalcaci Cad, Saglik Apt, 5/5 42060 Konya, Turkey; e-mail: adzamani@hotmail.com



Chest. 2004;125(5):1966-1967. doi:10.1378/chest.125.5.1966
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To the Editor:

I read with great interest the review by Datta et al (June 2003)1regarding the preoperative evaluation of patients undergoing lung surgery. The authors emphasized that before taking a patient with lung cancer to surgery, the presence of a coexisting disease, especially COPD, should be sought to provide the optimal treatment and control of the disease. I think that the presence of COPD also should be sought in patients who undergo nonthoracic surgery, because COPD patients are more sensitive to the ventilatory depressant effects of inhalation anesthetics, thereby increasing their risk of hypercarbia and respiratory depression.2These patients also have an increased risk of postoperative pulmonary complications (relative risk range, 2.7 to 4.7).3A preoperative evaluation of the patient is necessary to identify and limit the anesthesiologic and surgical risks associated with the intended procedure. Furthermore, this assessment can uncover occult conditions that could cause problems during and after the operation.45

Over a 5-month period, I carried out pulmonary consultations at the Selçuk University Hospital, which is a 571-bed teaching hospital in Konya, Turkey. In total, 133 patients were evaluated during this period. A preoperative pulmonary assessment was performed in 85 patients (63.9%) from different surgical departments. In addition to a detailed medical history and physical examination, the following preoperative laboratory tests were ordered routinely: CBC; blood biochemistry analysis; urinalysis; ECG; chest roentgenography; and pulmonary function tests. For further investigation, when needed, arterial blood gas analysis, thoracic ultrasonography, chest CT scan, bronchoscopy, thoracentesis, pleural biopsy, sputum examination for acid-fast bacilli, and tuberculin skin test were performed. More than 90% of patients sought consultation in the following surgical departments: general surgery (25 patients); urology (19 patients); orthopedics (19 patients); otolaryngology (9 patients); and neurosurgery (7 patients). Of the 85 patients, there were 59 men and 26 women, with a mean (± SD) age of 63.4 ± 13.24 years (range, 18 to 95 years). Twenty-nine patients (34.1%) were heavy smokers (ie, > 20 pack-years). The most common symptoms were dyspnea (27%), cough (26%), and sputum production (20%). Diagnoses made after consultations in 52 patients (61.2%) are presented in Table 1 . Of the 85 patients, no abnormalities in the respiratory system were found in 33 (38.8%).

These findings indicate that almost all diagnoses made preoperatively were related to chronic illnesses, and the most common disease revealed was COPD, followed by pleural diseases and tuberculosis. Thus, the pulmonary consultant’s awareness of these disorders in conjunction with proper treatment will lead to a decrease in the possibility of severe postoperative complications.

Table Graphic Jump Location
Table 1. Diagnoses Made After Preoperative Pulmonary Consultations in 52 Patients
Datta, D, Lahiri, B (2003) Preoperative evaluation of patients undergoing lung resection surgery.Chest123,2096-2103. [CrossRef] [PubMed]
 
Sykes, LA, Bowe, EA Cardiorespiratory effects of anesthesia.Clin Chest Med1993;14,211-226. [PubMed]
 
Smetana, GW Preoperative pulmonary evaluation.N Engl J Med1999;340,937-944. [CrossRef] [PubMed]
 
Knape, JTA Preoperative screening and preoperative medicine: a new challenge for anesthesiology and internal medicine.Neth J Med2000;56,4-6. [CrossRef] [PubMed]
 
Roizen, MF Preoperative evaluation of patients: a review.Ann Acad Med Singapore1994;23(suppl),49S-55S
 

Preoperative Pulmonary Consultation at a University Hospital

To the Editor:

As you know, our article was devoted to the preoperative evaluation of patients undergoing lung resection surgery. We did not include any patients undergoing nonthoracic surgery, and appropriately so. Dr. Zamani’s concern is real, but it is irrelevant. There is no doubt that there is increased morbidity in patients undergoing nonthoracic surgery in the presence of advanced COPD with or without respiratory failure, which has been well-documented. The only comment I have is that the most important preoperative evaluation for patients with advanced COPD, with or without respiratory failure, who are undergoing abdominal surgery is arterial blood gas analysis, rather than an investigation of pulmonary mechanics. This is particularly so in patients who have any evidence of preexisting hypercapnia. Although Professor Zamani raised a valuable question regarding our article, it is irrelevant.


Figures

Tables

Table Graphic Jump Location
Table 1. Diagnoses Made After Preoperative Pulmonary Consultations in 52 Patients

References

Datta, D, Lahiri, B (2003) Preoperative evaluation of patients undergoing lung resection surgery.Chest123,2096-2103. [CrossRef] [PubMed]
 
Sykes, LA, Bowe, EA Cardiorespiratory effects of anesthesia.Clin Chest Med1993;14,211-226. [PubMed]
 
Smetana, GW Preoperative pulmonary evaluation.N Engl J Med1999;340,937-944. [CrossRef] [PubMed]
 
Knape, JTA Preoperative screening and preoperative medicine: a new challenge for anesthesiology and internal medicine.Neth J Med2000;56,4-6. [CrossRef] [PubMed]
 
Roizen, MF Preoperative evaluation of patients: a review.Ann Acad Med Singapore1994;23(suppl),49S-55S
 
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