Perioperative Care of the Orthopedic Patient with Chronic Pulmonary Disease

  • Kethy M. Jules-ElyséeEmail author


This chapter reviews the impact of chronic pulmonary disease on postoperative outcome. Preexisting pulmonary disease is the most important predictor of postoperative pulmonary complications; indeed such impairment confers risks in the surgical setting rivaling that of the more dreaded cardiac complications. Herein the utility of various preoperative assessments such as arterial blood gases and spirometry is reviewed, and the less appreciated predictive role of the serum albumin and blood urea nitrogen is discussed.


Chronic pulmonary disease Orthopedic patient Orthopedic surgery Preoperative assessments Arterial blood gases Spirometry Serum albumin Blood urea nitrogen 


  1. 1.
    Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med. 1995;10(12):671–8.CrossRefGoogle Scholar
  2. 2.
    Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;162(18):2053–7.CrossRefPubMedGoogle Scholar
  3. 3.
    McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005;171(5):514–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000. Crit Care Med. 2003;31(7):1930–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Ephgrave KS, Kleiman-Wexler R, Pfaller M, Booth B, Werkmeister L, Young S. Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery. 1993;114(4):815–9; discussion 9–21.PubMedGoogle Scholar
  6. 6.
    Mitchell CK, Smoger SH, Pfeifer MP, Vogel RL, Pandit MK, Donnelly PJ, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998;133(2):194–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Canet J, Mazo V. Postoperative pulmonary complications. Minerva Anestesiol. 2010;76(2):138–43.PubMedGoogle Scholar
  8. 8.
    Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Aust J Physiother. 2009;55(3):191–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Diaz-Fuentes G, Hashmi HR, Venkatram S. Perioperative evaluation of patients with pulmonary conditions undergoing non-cardiothoracic surgery. Health Serv Insights. 2016;9(Suppl 1):9–23.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Snow V, Qaseem A, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007;146(3):204–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112(1):113–21.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21.CrossRefGoogle Scholar
  14. 14.
    Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med. 1992;152(1):125–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581–95.CrossRefGoogle Scholar
  17. 17.
    Kocabas A, Kara K, Ozgur G, Sonmez H, Burgut R. Value of preoperative spirometry to predict postoperative pulmonary complications. Respir Med. 1996;90(1):25–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Maddox L, Schwartz DA. The pathophysiology of asthma. Annu Rev Med. 2002;53:477–98.CrossRefPubMedGoogle Scholar
  20. 20.
    Warner DO, Warner MA, Barnes RD, Offord KP, Schroeder DR, Gray DT, et al. Perioperative respiratory complications in patients with asthma. Anesthesiology. 1996;85(3):460–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Gold MI, Helrich M. A study of complications related to anesthesia in asthmatic patients. Anesth Analg. 1963;42:238–93.CrossRefPubMedGoogle Scholar
  22. 22.
    Shnider SM, Papper EM. Anesthesia for the asthmatic patient. Anesthesiology. 1961;22:886–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Silvanus MT, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology. 2004;100(5):1052–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932–46.CrossRefPubMedGoogle Scholar
  25. 25.
    Saetta M, Di Stefano A, Turato G, Facchini FM, Corbino L, Mapp CE, et al. CD8+ T-lymphocytes in peripheral airways of smokers with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(3 Pt 1):822–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Trayner E Jr, Celli BR. Postoperative pulmonary complications. Med Clin North Am. 2001;85(5):1129–39.CrossRefPubMedGoogle Scholar
  27. 27.
    Gupta H, Ramanan B, Gupta PK, Fang X, Polich A, Modrykamien A, et al. Impact of COPD on postoperative outcomes: results from a national database. Chest. 2013;143(6):1599–606.CrossRefPubMedGoogle Scholar
  28. 28.
    Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 1995;80(2):276–84.PubMedGoogle Scholar
  29. 29.
    Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498–503.CrossRefPubMedGoogle Scholar
  30. 30.
    Mak PH, Irwin MG, Ooi CG, Chow BF. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia. 2001;56(4):352–6.CrossRefPubMedGoogle Scholar
  31. 31.
    McGlothlin DDMT. Preoperative risk assessment of pulmonary arterial hypertension patients undergoing general surgery. ADV Pulmon Hypertens. 2007;6(2):66–73.CrossRefGoogle Scholar
  32. 32.
    Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Intern Med. 1986;104(4):540–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Clavellina-Gaytan D, Velazquez-Fernandez D, Del-Villar E, Dominguez-Cherit G, Sanchez H, Mosti M, et al. Evaluation of spirometric testing as a routine preoperative assessment in patients undergoing bariatric surgery. Obes Surg. 2015;25(3):530–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232(2):242–53.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Turan A, Mascha EJ, Roberman D, Turner PL, You J, Kurz A, et al. Smoking and perioperative outcomes. Anesthesiology. 2011;114(4):837–46.CrossRefPubMedGoogle Scholar
  36. 36.
    Warner MA, Divertie MB, Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. Anesthesiology. 1984;60(4):380–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998;113(4):883–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Nakagawa M, Tanaka H, Tsukuma H, Kishi Y. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest. 2001;120(3):705–10.CrossRefPubMedGoogle Scholar
  39. 39.
    Myers K, Hajek P, Hinds C, McRobbie H. Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis. Arch Intern Med. 2011;171(11):983–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248(5):739–45.CrossRefPubMedGoogle Scholar
  41. 41.
    Moller AM, Villebro N, Pedersen T, Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359(9301):114–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268–79.CrossRefPubMedGoogle Scholar
  43. 43.
    Dilworth JP, White RJ. Postoperative chest infection after upper abdominal surgery: an important problem for smokers. Respir Med. 1992;86(3):205–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Barrera R, Shi W, Amar D, Thaler HT, Gabovich N, Bains MS, et al. Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. Chest. 2005;127(6):1977–83.CrossRefPubMedGoogle Scholar
  45. 45.
    McAllister-Sistilli CG, Caggiula AR, Knopf S, Rose CA, Miller AL, Donny EC. The effects of nicotine on the immune system. Psychoneuroendocrinology. 1998;23(2):175–87.CrossRefPubMedGoogle Scholar
  46. 46.
    W-Dahl A, Toksvig-Larsen S. Cigarette smoking delays bone healing: a prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand. 2004;75(3):347–51.CrossRefPubMedGoogle Scholar
  47. 47.
    Gronkjaer M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71.CrossRefPubMedGoogle Scholar
  48. 48.
    Narkiewicz K, van de Borne PJ, Hausberg M, Cooley RL, Winniford MD, Davison DE, et al. Cigarette smoking increases sympathetic outflow in humans. Circulation. 1998;98(6):528–34.CrossRefPubMedGoogle Scholar
  49. 49.
    Rietbrock N, Kunkel S, Worner W, Eyer P. Oxygen-dissociation kinetics in the blood of smokers and non-smokers: interaction between oxygen and carbon monoxide at the hemoglobin molecule. Naunyn Schmiedeberg’s Arch Pharmacol. 1992;345(1):123–8.CrossRefGoogle Scholar
  50. 50.
    Buist AS, Sexton GJ, Nagy JM, Ross BB. The effect of smoking cessation and modification on lung function. Am Rev Respir Dis. 1976;114(1):115–22.PubMedGoogle Scholar
  51. 51.
    Warner DO. Perioperative abstinence from cigarettes: physiologic and clinical consequences. Anesthesiology. 2006;104(2):356–67.CrossRefPubMedGoogle Scholar
  52. 52.
    Thompson WH, Nielson CP, Carvalho P, Charan NB, Crowley JJ. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med. 1996;154(2 Pt 1):407–12.CrossRefPubMedGoogle Scholar
  53. 53.
    Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76(Suppl 4):S60–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Eichhorn JH. Pulse oximetry monitoring and late postoperative hypoxemia on the general care floor. J Clin Monit Comput. 1998;14(1):49–55.CrossRefPubMedGoogle Scholar
  55. 55.
    Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil. 1998;79(1):5–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Hall JC, Tarala R, Harris J, Tapper J, Christiansen K. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet. 1991;337(8747):953–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg. 2008;247(4):617–26.CrossRefPubMedGoogle Scholar
  58. 58.
    Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005;293(5):589–95.CrossRefPubMedGoogle Scholar
  59. 59.
    Tusman G, Bohm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol. 2012;25(1):1–10.CrossRefPubMedGoogle Scholar
  60. 60.
    Kindgen-Milles D, Muller E, Buhl R, Bohner H, Ritter D, Sandmann W, et al. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest. 2005;128(2):821–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239–43.CrossRefPubMedGoogle Scholar
  62. 62.
    Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1188–98.CrossRefPubMedGoogle Scholar
  63. 63.
    Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, et al. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140(5):1207–15.CrossRefGoogle Scholar
  64. 64.
    Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88(11):1241–9.CrossRefGoogle Scholar
  65. 65.
    Price LC, Montani D, Jais X, Dick JR, Simonneau G, Sitbon O, et al. Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension. Eur Respir J. 2010;35(6):1294–302.CrossRefPubMedGoogle Scholar
  66. 66.
    Meyer S, McLaughlin VV, Seyfarth HJ, Bull TM, Vizza CD, Gomberg-Maitland M, et al. Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey. Eur Respir J. 2013;41(6):1302–7.CrossRefPubMedGoogle Scholar
  67. 67.
    Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005;45(10):1691–9.CrossRefGoogle Scholar
  68. 68.
    Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth. 2007;99(2):184–90.CrossRefPubMedGoogle Scholar
  69. 69.
    Kaw R, Sharma P, Minai OA. What risks does a history of pulmonary hypertension present for patients undergoing noncardiac surgery? Cleve Clin J Med. 2007;74(Suppl 1):S20–1.CrossRefPubMedGoogle Scholar
  70. 70.
    Memtsoudis SG, Ma Y, Chiu YL, Walz JM, Voswinckel R, Mazumdar M. Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement. Anesth Analg. 2010;111(5):1110–6.CrossRefGoogle Scholar
  71. 71.
    Mellor A, Soni N. Fat embolism. Anaesthesia. 2001;56(2):145–54.CrossRefPubMedGoogle Scholar
  72. 72.
    Arthurs MH, Morgan OS, Sivapragasam S. Fat embolism syndrome following long bone fractures. West Indian Med J. 1993;42(3):115–7.PubMedGoogle Scholar
  73. 73.
    Barst RJ. Medical therapy of pulmonary hypertension. An overview of treatment and goals. Clin Chest Med. 2001;22(3):509–15, ix.CrossRefPubMedGoogle Scholar
  74. 74.
    Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology. 2003;99(6):1415–32.CrossRefPubMedGoogle Scholar
  75. 75.
    Cottini SR, Lerch N, de Perrot M, Treggiari MM, Spiliopoulos A, Nicod L, et al. Risk factors for reperfusion injury after lung transplantation. Intensive Care Med. 2006;32(4):557–63.CrossRefPubMedGoogle Scholar
  76. 76.
    Krowka MJ, Plevak DJ, Findlay JY, Rosen CB, Wiesner RH, Krom RA. Pulmonary hemodynamics and perioperative cardiopulmonary-related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transpl. 2000;6(4):443–50.CrossRefPubMedGoogle Scholar
  77. 77.
    Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5–14.CrossRefPubMedGoogle Scholar
  78. 78.
    Rubin LJ. Pulmonary arterial hypertension. Proc Am Thorac Soc. 2006;3(1):111–5.CrossRefPubMedGoogle Scholar
  79. 79.
    Hamdan MA, Abu-Sulaiman RM, Najm HK. Sildenafil in pulmonary hypertension secondary to unilateral agenesis of pulmonary artery. Pediatr Cardiol. 2006;27(2):279–81.CrossRefPubMedGoogle Scholar
  80. 80.
    Michelakis E, Tymchak W, Lien D, Webster L, Hashimoto K, Archer S. Oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary arterial hypertension: comparison with inhaled nitric oxide. Circulation. 2002;105(20):2398–403.CrossRefPubMedGoogle Scholar
  81. 81.
    Rauch H, Motsch J, Bottiger BW. Newer approaches to the pharmacological management of heart failure. Curr Opin Anaesthesiol. 2006;19(1):75–81.CrossRefPubMedGoogle Scholar
  82. 82.
    Braun EB, Palin CA, Hogue CW. Vasopressin during spinal anesthesia in a patient with primary pulmonary hypertension treated with intravenous epoprostenol. Anesth Analg. 2004;99(1):36–7.CrossRefPubMedGoogle Scholar
  83. 83.
    Fischer LG, Van Aken H, Burkle H. Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists. Anesth Analg. 2003;96(6):1603–16.CrossRefPubMedGoogle Scholar
  84. 84.
    Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology. 2000;92(5):1467–72.CrossRefPubMedGoogle Scholar
  85. 85.
    Groeben H, Schafer B, Pavlakovic G, Silvanus MT, Peters J. Lung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery. Anesthesiology. 2002;96(3):536–41.CrossRefPubMedGoogle Scholar
  86. 86.
    Gruber EM, Tschernko EM, Kritzinger M, Deviatko E, Wisser W, Zurakowski D, et al. The effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 2001;92(4):1015–9.CrossRefPubMedGoogle Scholar
  87. 87.
    Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118(5):1046–58.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;(3):Cd003071.Google Scholar
  89. 89.
    Wu CL, Anderson GF, Herbert R, Lietman SA, Fleisher LA. Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patients. Reg Anesth Pain Med. 2003;28(4):271–8.PubMedGoogle Scholar
  90. 90.
    Pedersen T, Viby-Mogensen J, Ringsted C. Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand. 1992;36(8):812–8.CrossRefPubMedGoogle Scholar
  91. 91.
    Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000;84(4):450–5.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Hausman MS Jr, Jewell ES, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg. 2015;120(6):1405–12.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD. A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br. 2009;91(7):935–42.CrossRefPubMedGoogle Scholar
  94. 94.
    Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg. 1998;87(1):93–7.PubMedGoogle Scholar
  96. 96.
    Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008;100(2):154–64.CrossRefPubMedGoogle Scholar
  97. 97.
    YaDeau JT, Cahill JB, Zawadsky MW, Sharrock NE, Bottner F, Morelli CM, et al. The effects of femoral nerve blockade in conjunction with epidural analgesia after total knee arthroplasty. Anesth Analg. 2005;101(3):891–5, table of contents.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Memtsoudis SG, Poeran J, Cozowicz C, Zubizarreta N, Ozbek U, Mazumdar M. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study. Pain. 2016;157(10):2341–9.CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    McIsaac DI, Wong CA, Bryson GL, van Walraven C. Association of polypharmacy with survival, complications, and healthcare resource use after elective noncardiac surgery: a population-based cohort study. Anesthesiology. 2018;128(6):1140–50.CrossRefPubMedGoogle Scholar
  100. 100.
    Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;(1):Cd004603.Google Scholar
  101. 101.
    Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005;94(4):505–13.CrossRefPubMedGoogle Scholar
  102. 102.
    Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005;102(6):1249–60.CrossRefPubMedGoogle Scholar
  103. 103.
    Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007;104(6):1545–56, table of contents.CrossRefPubMedGoogle Scholar
  104. 104.
    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardization of spirometry. Eur Respir J. 2005;26(2):319–38.CrossRefPubMedGoogle Scholar
  105. 105.
    Bapoje SR, Whitaker JF, et al. Preoperative evaluation of the patient with pulmonary disease. Chest. 2007;132(5):1637–45.CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care, and Pain ManagementHospital for Special SurgeryNew YorkUSA
  2. 2.Department of AnesthesiologyWeill Cornell MedicineNew YorkUSA

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