[Perioperative respiratory therapy and postoperative pain therapy]

Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are susceptible to post-operative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. Perioperative use of incentive spirometers, breathing exercises or IPPB seems to reduce the incidence of postoperative pulmonary complications. Opioids are used usually for postoperative pain management, but unfortunately they are given mainly as i.m. injections, although an i.v. administration would be far better. If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.