A 56-Year-Old Man Is Evaluated in the Preoperative Clinic 4

A 56-year-old man is evaluated in the preoperative clinic 4 weeks prior to an elective right knee replacement for severe osteoarthritis.  Medical history is notable for hypertension and chronic obstructive pulmonary disease.  The patient uses inhaled bronchodilators, inhaled corticosteroids, and amlodipine.  He has never required hospitalization for respiratory-related issues.  The patient is able to perform all basic activities of daily living without dyspnea and was playing golf once a week prior to the knee pain limiting his activity.  He previously smoked a pack of cigarettes daily beginning at age of 21 but has cut down to 3 or 4 cigarettes per day over the last 2 years.  Vital signs are within normal limits.  Oxygen saturation is 92% on room air.  Lung auscultation shows slightly diminished breath sounds with prolonged expiration but no wheezes or crackles.  Heart sounds are normal.  The abdomen is soft and nontender with no organomegaly.  There is no extremity edema.  The right knee has crepitus and decreased range of motion.  Blood cell counts and serum chemistry studies are within normal limits.  Which of the following interventions is most appropriate to decrease the risk of postoperative pulmonary complications in this patient?

A) Immediate smoking cessation
B) Long-term oxygen therapy
C) Preoperative moxifloxacin
D) Systemic glucocorticoids
E) Theophylline therapy

Correct Answer:

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