ABSTRACT
By virtue of age and smoking, the typical lung volume reduction surgery (LVRS) patient is at risk for numerous chronic medical problems in addition to emphysema. Long-term cigarette smoking increases risk for ischemic heart disease, cor pulmonale, pulmonary hypertension, diabetes, peripheral vascular disease, and gastrointestinal problems. Advanced age and chronic corticosteroid use also contribute to the higher potential complication rate in this patient population. These fragile patients require compulsive attention to prevent and manage the complications of anesthesia and thoracic surgery. Risks can be minimized by careful patient evaluation and selection, which are detailed in Chapter 7. However, even in ideal candidates, the risk of serious morbidity or mortality is substantial, especially for an elective surgical procedure. This chapter reviews the preparation of these patients for LVRS as well as the perioperative management and management of complications common to the technique.
