[Preoperative assessment of the patient with restrictive lung disease]

Restrictive lung disease is characterized by a reduction in total lung capacity. Pulmonary conditions such as interstitial lung disease related to connective tissue disease, idiopathic interstitial pneumonia (IIP), lung resection, and pulmonary fibrosis could cause restrictive disease. In addition, extrapulmonary disorders are caused by chest wall limitations, muscle dysfunction, or pleural disease. Preoperative medical history of associated diseases or symptoms prompts the anesthesiologist to the directed evalution. With regard to the restrictive lung disease, IIP is the most important disease for an anesthesiologist to know. IIP is known to be combined with primary lung cancer and is associated with an increased risk of postoperative acute exacerbation. Acute exacerbation of IIP is a serious postoperative complication and the consequence is extremely poor. Therefore, both surgeons and anesthesiologists must aim to prevent acute exacerbation of IIP Although it is difficult to predict the development of acute exacerbation of IIP, we should avoid or postpone the surgery in patients demonstrating an active phase of IIP. Besides, we should give enough explanation of the risk of postoperative acute exacerbation to the patient with IIP.