Pneumonia

Defer elective surgery - Active pneumonia is a reason to postpone elective cases until treated and recovered; the risk of perioperative pulmonary complications is high.

Optimize oxygenation - Compromised gas exchange means less reserve — preoxygenate well, expect faster desaturation, and titrate ventilation and PEEP to support oxygenation.

Secretions and reactive airway - Increased secretions and airway reactivity raise the risk of bronchospasm and plugging; have suction ready and consider bronchodilators.

Sepsis - Severe pneumonia brings systemic sepsis; support hemodynamics and continue antibiotics.

Postoperative pulmonary care - Use aggressive pulmonary toilet, analgesia that permits deep breathing, and a low threshold for continued respiratory support.

Pneumonia is infection of the lung parenchyma — bacterial, viral, or fungal — causing alveolar inflammation and consolidation, impaired gas exchange, and, when severe, hypoxemia, sepsis, and ARDS.

For the anesthetist, active pneumonia means compromised oxygenation and pulmonary reserve, increased secretions and reactive airways, and possible systemic sepsis. Elective surgery is usually deferred until treated; when surgery is unavoidable, the lungs are the central problem.