Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In his Clinical Crossroads discussion of a patient with severe pulmonary disease contemplating major abdominal surgery, Dr Smetana1 provides a concise review of preoperative assessment and perioperative risk reduction strategies for patients susceptible to postoperative pulmonary complications (PPCs). He cites evidence that he suggests favors the use of intraoperative neuraxial blockade (rather than general anesthesia) and postoperative epidural analgesia for reduction of PPCs in high-risk patients. However, conclusions regarding the superiority of these techniques must be interpreted cautiously.
Atkins RF. COPD and Abdominal Surgery. JAMA. 2007;298(10):1158-1159. doi:10.1001/jama.298.10.1158-a