Postoperative pulmonary complications (PPCs) are a significant cause of morbidity and mortality following surgery and anesthesia. This article aims to explore the etiology, risk factors, and prevention strategies associated with PPCs. PPCs encompass a wide spectrum of respiratory complications, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis. Multiple patient-related and surgical-related risk factors contribute to the development of PPCs, such as pre-existing lung disease, smoking history, advanced age, prolonged anesthesia, and surgical site. Several preventive measures throughout the preoperative to postoperative periods have been proposed to minimize the incidence and severity of PPCs. The preoperative evaluation should have a coordinated approach that integrates risk assessment tools to provide personalized care to the patients’ specific risk profile. Preoperative optimization of lung function through smoking cessation, respiratory muscle training, and bronchodilator therapy can attenuate the risk. Intraoperative lung-protective ventilation strategies, including low tidal volume ventilation, positive end-expiratory pressure (PEEP), and recruitment maneuvers have shown promising results. Early mobilization, incentive spirometry, and pulmonary rehabilitation programs in the postoperative period also play a significant role in preventing complications. PPCs pose a considerable challenge in the perioperative period. Understanding the multifactorial etiology and implementing appropriate preventive strategies can reduce the burden of these complications, improve patient outcomes, and enhance overall surgical care.

Functional capacity assessment is important for perioperative risk stratification; however, there are currently limited options for objective and economical functional capacity evaluation. Pedometer functions are now widely available in mobile devices and offer a nonintrusive and objective approach to measuring patient activity level over time. Therefore, we conducted this systematic review to assess the value of pedometer readings in predicting perioperative outcomes. We systematically searched PubMed, EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science Citation Index for studies, which assessed the correlation between perioperative (30 days before to 30 days after surgery) pedometer data and perioperative outcomes. We identified a total of 18 studies for inclusion. Seven of the studies recorded preoperative pedometer data, and 13 studies recorded postoperative pedometer data. Notably, 10 of the studies covered oncologic surgery patients. The included studies consistently reported that preoperative pedometer readings correlated with postoperative complication rates. In addition, in-hospital postoperative pedometer readings correlated with postdischarge complications and readmissions. Perioperative pedometer data demonstrated consistent and biologically plausible association with perioperative outcomes. Further studies are needed to validate the use of pedometer in the perioperative period and to identify the optimal approach for its use to potentially improve patient outcomes.

Tricuspid atresia (TA) is a cyanotic congenital heart defect defined by agenesis of the tricuspid valve and resultant right ventricular hypoplasia, representing 1.4–2.9% of congenital heart disease. Survival depends on interatrial and interventricular shunts that permit systemic and pulmonary blood flow, with staged surgical palliation culminating in the Fontan procedure. While surgical advances have improved long-term outcomes, Fontan circulation remains a delicate physiology characterized by preload dependence, elevated pulmonary vascular resistance, chronic venous hypertension, and a prothrombotic state. These features predispose patients to arrhythmias, lymphatic complications, hepatic congestion, and progressive circulatory failure. For anesthesiologists, perioperative management of TA and Fontan patients is uniquely complex. Anesthetic considerations include meticulous preload optimization, modulation of systemic and pulmonary vascular resistance, and ventilatory strategies that minimize adverse effects on venous return. Additional challenges include the high risk of air embolism, individualized anticoagulation needs, and hemodynamic sensitivity to patient positioning. Preoperative evaluation with echocardiography and electrocardiography provides critical insight into anatomy and physiology, while intraoperative planning must emphasize goal-directed fluid management, careful agent selection, and tailored ventilation. Postoperatively, vigilant monitoring, effective pain control, and prevention of complications are essential. This review synthesizes classification systems, pathophysiology, and the evolution of surgical palliation, while emphasizing anesthetic principles for the perioperative care of patients with TA and Fontan circulation. As survival improves and the population of Fontan patients expands, a nuanced understanding of this physiology is essential for optimizing outcomes across cardiac and non-cardiac surgical settings.