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Postoperative pulmonary complications: Reducing risks for noncardiac surgery

doi: 10.1097/01.NPR.0000432024.23727.db
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INSTRUCTIONS Postoperative pulmonary complications: Reducing risks for noncardiac surgery

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Postoperative pulmonary complications: Reducing risks for noncardiac surgery

General Purpose: To present evidence-based guidelines for prevention of PPCs in patients undergoing noncardiac surgery. Learning Objectives: After reading the article and taking this test, the reader should be able to: 1. Describe PPCs and their risk stratification methods. 2. Identify evidence-based strategies to prevent PPCs in noncardiac surgical patients.

  1. What percentage of postoperative mortality is related to PPCs?
    1. 25%
    2. 35%
    3. 50%
    4. 70%
  2. Both pneumonia and acute respiratory failure can be directly attributed to
    1. postoperative hypoxemia.
    2. mechanical ventilation.
    3. general anesthesia.
    4. atelectasis.
  3. Postsurgical reduction in FVC persists for up to
    1. 1 week.
    2. 10 days.
    3. 2 weeks.
    4. 1 month.
  4. The most important risk factor for PPCs is related to
    1. type of anesthesia.
    2. surgical site.
    3. duration of surgery.
    4. elective versus emergency procedure.
  5. What is the CPRI score for a 72-year-old who had a myocardial infarction 4 months ago and smoked until 6 weeks ago?
    1. 2
    2. 3
    3. 4
    4. 16
  6. Arozullah and colleagues found the greatest risk for postoperative respiratory failure was associated with
    1. abdominal aortic aneurysm repair.
    2. thoracic surgery.
    3. neurosurgery.
    4. neck surgery.
  7. According to Fisher and colleagues, which variable was significantly associated with PPCs after noncardiac surgery in more than one study?
    1. patient age
    2. preoperative respiratory infection
    3. higher ASA class
    4. postoperative nasogastric tube placement
  8. According to the ACP's guidelines, the only lab test predictive of PPCs is
    1. hemoglobin.
    2. serum albumin.
    3. preoperative spirometry.
    4. hematocrit.
  9. Which of the following does the ACP notconsider to be a significant risk factor for PPCs?
    1. age 62
    2. ASA class 2
    3. obesity
    4. heart failure
  10. Which of the following does the ACP recommend to reduce PPC risk?
    1. incentive spirometry
    2. right-heart catheterization
    3. total parenteral nutrition
    4. routine preoperative antibiotic administration
  11. According to Lawrence and colleagues, which of the following reduced the risk of PPCs?
    1. epidural anesthesia
    2. selective use of nasogastric tubes after abdominal surgery
    3. laparoscopic surgical procedures
    4. long-acting neuromuscular blocking agents
  12. Patients at elevated risk for PPCs should start inspiratory muscle training
    1. within 24 hours after surgery.
    2. in the postanesthesia care unit.
    3. 1 day before surgery.
    4. 2 weeks before surgery.
  13. Deep-breathing exercises (3 sets of 10 breaths) should be performed
    1. starting 4 hours after extubation.
    2. 4 times per day for 7 days postoperatively.
    3. once per hour when awake for 4 days postoperatively.
    4. lying on one side.
  14. Which statement about incentive spirometry is accurate?
    1. The patient inhales and exhales through a mouthpiece into a measured chamber.
    2. It increases pleural pressure to promote gas exchange.
    3. It may prevent but not reverse postoperative atelectasis.
    4. It encourages at least 5 seconds of sustained lung inflation.
  15. Which of the following might decrease severe complications in patients who develop hypoxemia after abdominal surgery?
    1. inspiratory muscle training
    2. continuous positive airway pressure
    3. incentive spirometry
    4. administration of bronchodilators
  16. Levalbuterol is administered to treat
    1. atelectasis.
    2. hypoxemia.
    3. bronchospasm.
    4. respiratory failure.
  17. Preoperative pulmonary evaluation should always include
    1. a review of current pulmonary medications.
    2. pulmonary function testing.
    3. a chest X-ray.
    4. spirometry testing.
  18. Which of the following statements about PPCs is true?
    1. PPCs are less prevalent than cardiac complications.
    2. Patients at high risk for PPCs should start lung expansion interventions immediately after surgery.
    3. The likelihood of PPCs is best predicted using PPC risk indexes alone.
    4. A multifactorial approach is needed to prevent PPCs.
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