[Perioperative Management for Cardiovascular Surgery on the Patients with Pulmonary Dysfunction]

The factors influencing the pulmonary function after cardiovascular surgery are decreased compliance of thorax due to sternotomy, phrenic nerve injury, wound pain and decreased blood flow after internal mammary artery harvest on coronary artery bypass grafting (CABG). Another factor is systemic inflammatory response syndrome (SIRS) associated with cardio-pulmonary bypass. So, we should take care of pulmonary function after surgery not only on the patients with pulmonary dysfunction but also on the patients with normal pulmonary function. Because the results after cardiovascular surgery for the patients with pulmonary dysfunction depends on the severity of the pulmonary function, preoperative assessment of it is important. The predictor for adverse results are chronic obstructive lung disease(COPD) itself and FEV1.0%<50% and so on. Even of the patients has no history of pulmonary disease, preoperative evaluation is necessary. For the patients with pulmonary dysfunction, we should consider fast-track recovery after operation, meaning early extubation, choice of less invasive surgery procedure and change of surgical procedure. Prohibition of smoking for more than 4 weeks, pre- and post-operatively pulmonary rehabilitation are also important for improve the operative results.