INTEGRATED ANAESTHESIA AND PHYSIOTHERAPY STRATEGIES TO REDUCE POST-THORACOTOMY PULMONARY COMPLICATIONS

Post-thoracotomy pulmonary complications (PTPCs) remain a major source of postoperative morbidity,prolonged hospital stay,and mortality following thoracic surgery. These complicationsincluding atelectasis, pneumonia, hypoxemia, and respiratory failureresult from a complex interplay of surgical trauma, one-lung ventilation induced lung injury, impaired diaphragmatic function, postoperative pain, reduced lung volumes, and ineffective cough. Increasing evidence supports a multidisciplinary, integrated perioperative approach combining optimized anaesthetic management with structured physiotherapy interventions to mitigate these risks. Anaesthetic strategies focus on preoperative risk stratification and optimization, lung protective ventilation during one lung ventilation, judicious oxygen use, effective regional and multimodal analgesia to facilitate deep breathing and early mobilization, and opioid sparing techniques to minimize respiratory depression. Complementary physiotherapy strategies include preoperative pulmonary prehabilitation, early postoperative respiratory exercises, incentive spirometry, positive expiratory pressure therapy, airway clearance techniques, and early, progressive mobilization. Integration of these approaches within enhanced recovery after thoracic surgery (ERATS) pathways has been shown to reduce the incidence and severity of PTPCs, improve oxygenation and functional recovery, and shorten intensive care unit and hospital length of stay. Emerging concepts such as precision ventilation, ultrasound-guided continuous regional analgesia, digital physiotherapy platforms, wearable respiratory monitoring, and artificial intelligence-based risk prediction models offer promising avenues to further improve outcomes.