IMPORTANCE Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. OBJECTIVE To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. DESIGN, SETTING, AND PARTICIPANTS We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. EXPOSURE Noncardiothoracic surgery. MAIN OUTCOMES AND MEASURES Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. RESULTS This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59–12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67–3.89; and age [in years]: OR, 1.03, 95% CI, 1.02–1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03–2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80–0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05–1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05–1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01–1.24) factors. CONCLUSIONS AND RELEVANCE Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

Anaesthesiologists frequently encounter patients with diseases of the endocrine system, in particular diabetes mellitus. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular autonomic neuropathy, joint collagen tissue, and immune deficiency. Due to the fact that endocrine diseases can be associated with significant peri-operative morbidity and mortality, it is critical that anaesthesiologists understand these disorders and when indicated request the appropriate investigations.

In this study, we measure the radial artery internal diameter (RAID) in children up to 4 years of age before and after the induction of anesthesia. A B-mode portable color Doppler ultrasound was used to measure the RAID. Three sets of measurements were taken for each child before and after the induction of anesthesia and with the wrist in the neutral and dorsiflexed positions. The reliability of the mean value of the RAID in the three sets in 24 patients was established. There were discrepancies between the RAID and the proposed catheter size in some individuals, which may not only render placement difficult but also have potential for arterial injury. There are good reasons to measure the RAID in small children prior to insertion of an intra-arterial catheter.

Extubation in the OR can be safely performed in a select group of cardiac surgery patients without any increase in postoperative morbidity or mortality. The proposed mathematical model performed reasonably well in predicting a successful extubation in the OR.