A small step in the right direction for reducing postoperative pulmonary complications

Only 12 yr after the first successful public demonstration of general anaesthesia in 1846, one of the first adverse effects to be described was reported by John Snow: ‘If the inhalation is continued the breathing is rendered difficult, feeble, or irregular, and is sometimes performed only by the diaphragm, whilst the intercostal muscles are paralysed. If the dose of chloroform is gradually increased after these effects are produced, the breathing entirely ceases’.1 Ever since this observation, the fact that anaesthesia can cause postoperative chest complications has been widely accepted by anaesthetists, so it is surprising that only relatively recently have serious efforts been made to understand the aetiology of this common problem, with a view to being able to their prediction and prevention. The term postoperative pulmonary complication (PPC) has become widely adopted and describes a single outcome measure representing a disparate collection of complications linked only by a common organ of origin. PPCs are more common than cardiovascular complications, have a significant impact on outcome measures such as length of hospital stay, increase healthcare costs, and when severe are associated with increased mortality