Key messages

• The vital capacity and functional residual capacity can fall by 50 to 70 per cent during the first 24 h after surgery. These changes occur shortly after induction of anesthesia and can last 7 to 14 days.

• Cough and mucociliary transport are the most important mechanisms for protecting the lung from environmental and infectious agents. Mucociliary clearance is reduced for 2 to 6 days after general anesthesia.

• Management of postoperative pulmonary dysfunction starts before surgery. Risk factors for pulmonary complications include upper abdominal or thoracic surgery, general debility, cigarette smoking, and hypercapnea. Deep breathing exercises and incentive spirometry significantly reduce the length of stay and pulmonary complications. These exercises should be implemented prior to surgery when possible and continued for at least 3 to 4 days depending on the patient's progress.

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