Postoperative respiratory muscle dysfunction: Pathophysiology and preventive strategies

Nobuo Sasaki, Matthew J. Meyer, Matthias Eikermann

Research output: Contribution to journalReview articlepeer-review

67 Scopus citations

Abstract

Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

Original languageEnglish (US)
Pages (from-to)961-978
Number of pages18
JournalAnesthesiology
Volume118
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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