Risk of periprocedural complications in patients with respiratory disease

The risk of periprocedural complications depends on the type of procedure and the nature of the respiratory disease.

Procedures that put patients with respiratory disease at most risk are:

  • procedures involving the throat, thorax and abdomen
  • procedures with long operating duration
  • procedures requiring high levels of postprocedural analgesia.

Patients with respiratory disease at most risk of postprocedural complications are those:

  • who smoke
  • with poorly controlled asthma or history of severe exacerbations (especially those requiring intensive care or hospital admissions)
  • taking long-term systemic or high-dose inhaled corticosteroids—a brief course of supplementary corticosteroids may be needed periprocedurally
  • with limited mechanical ventilatory reserve, including patients with
    • severe airway obstruction
    • interstitial lung disease
    • an oxygen requirement or on domiciliary oxygen therapy
    • obesity
    • diseases associated with weak respiratory muscles (eg neuromuscular disease)
  • with mucus hypersecretion, including patients with
    • chronic bronchitis
    • bronchiectasis
    • cystic fibrosis
  • with a chest wall disorder causing a rigid chest (eg kyphoscoliosis)
  • with reduced ability to protect the upper airway or to clear secretions from the lungs (eg due to neuromuscular disorders affecting the bulbar muscles and cough mechanism)
  • with uncontrolled gastro-oesophageal reflux
  • with coexisting cardiac disease predisposing to pulmonary oedema
  • with significant sleep apnoea or obesity hypoventilation syndrome
  • with significant craniofacial abnormalities (who may be difficult to intubate and are more likely to have obstructive sleep apnoea)
  • who are prone to respiratory centre depression (eg due to chronic carbon dioxide retention)
  • who have difficulty cooperating with instructions (eg with physical or developmental disability).

Acute viral and bacterial infections can temporarily affect mucociliary function and increase mucus production. This can increase the risk of postprocedural complications. In otherwise healthy people, this risk is relatively low, but elective procedures may need to be postponed with consideration of the risks and benefits by the anaesthetist and surgeon.