الفهرس 
Introduction and aim of the work………Only 14 pages are availabe for public view
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Abstract
Perioperative pulmonary complications play an important role in the risk for patients undergoing surgery. They are as prevalent as cardiac complications and contribute similarly to morbidity, mortality, and length of hospital stay. Pulmonary complications may even be more likely than cardiac complications to predict long-term mortality after surgery (70) . Potential patient-related risk factors fell into the following general categories: age; chronic lung disease; cigarette use; congestive heart failure; functional dependence; American Society of Anesthesiologists (ASA) classification; obesity; asthma; obstructive sleep apnea; impaired sensorium, abnormal findings on chest examination, alcohol use, and weight loss; and exercise capacity, diabetes, and HIV infection (71). Procedure-related risk factors include surgical site, duration of surgery and type of anesthetics used (71) . Laparoscopic abdominal surgery, particularly cholecystectomy, is associated with fewer postoperative pulmonary abnormalities and a shorter hospital stay. These techniques use small incisions, and the reduced manipulation of visceral organs minimizes the adverse effects on respiratory muscles. Laparoscopic surgery leads to a 23% decrease in forced vital capacity (FVC) and a 16% decrease in FEV1, and it is associated with a lower incidence of complications compared with laparatomy; therefore, even patients with severe COPD can tolerate surgery (81) . Preoperative pulmonary assessment include detection of pulmonary risk factors and preoperative investigations as chest x-ray, ABG, PFTs and flow volume loops (87) . Summary [ 163 Interventions aimed at decreasing pulmonary complications associated with anesthesia should begin prior to operation and continue throughout the perioperative periods. These interventions should be carried out regardless of the risk of development of postoperative pulmonary complications (106) . Preoperative strategies include smoking cessation, Optimize asthma control before surgery, Inspiratory muscle training, patient education and preoperative antibiotics (111) . Intraoperative strategies include proper choice of the anesthetic method, decreasing the duration of surgery and proper choice of type of ventilatory management during general anesthesia (117) . Post operative strategies include lung expansion maneuver, good pain control and prevention of thromboembolism (123) . The purpose of this guideline is to provide guidance to clinicians on clinical and laboratory predictors of perioperative pulmonary risk before surgery. It also evaluates strategies to reduce the perioperative.