[Respiratory risk of general surgery in adults]

Disorders of ventilation and postoperative bronchial and pulmonary infections still create serious problems in general surgery. Three factors determine these complications: (1) the transient and usually resolutive repercussions of anaesthesia on ventilation; (2) the sometimes deep and prolonged alteration of lung function directly due to the surgical procedure, and (3) the patient's underlying condition. In practice, this last group of surgical patients can be divided into fragile subjects (elderly people, pregnant women), subjects at risk (smokers, malnourished or obese patients) and disabled subjects suffering from chronic obstructive or restrictive lung disease, asthma or heart disease. Preoperative clinical, radiological and, chiefly, functional evaluation leads to preventive measures. Preparation for surgery relies, to a great extent, on respiratory physiotherapy which, if needed, may be integrated in a pneumological therapeutic program. Combined with an efficient postoperative analgesia and with an optional anaesthesia technique, respiratory physiotherapy is essential to the prevention of respiratory complications in surgery.