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These complications negatively impact patient outcomes, including increased healthcare resource utilization and increased surgical mortality. In these children, the existing respiratory reserve is often inadequate to withstand the stresses brought on during anesthesia and surgery. A thorough clinical assessment and objective evaluation of pulmonary function and gas exchange can help identify which children are at particular risk for poor postoperative outcomes and thus merit preoperative interventions. These may include initiation and optimization of non\u2010invasive ventilation and mechanical insufflation\u2010exsufflation. Furthermore, such an evaluation will help identify children who may require a postoperative extubation plan tailored to neuromuscular diseases. Such strategies may include avoidance of pre\u2010extubation lung decruitment by precluding continuous positive airway pressure trials, aggressively weaning to room air and directly extubating to non\u2010invasive ventilation with a high inspiratory to expiratory pressure differential of at least 10\u00a0cm H20. Children with cerebral palsy and other neurodegenerative or neurodevelopmental disorders are a more heterogeneous group of children who may share some operative risk factors with children with neuromuscular disease; they may also be at risk of sleep\u2010disordered breathing, may also require non\u2010invasive ventilation or mechanical insufflation\u2010exsufflation, and may have associated chronic lung disease from aspirations that may require perioperative treatment.<\/jats:p>","DOI":"10.1111\/pan.14359","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T05:19:01Z","timestamp":1638681541000},"page":"228-236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Respiratory prehabilitation in pediatric anesthesia in children with muscular and neurologic disease"],"prefix":"10.1111","volume":"32","author":[{"given":"Aaron","family":"St\u2010Laurent","sequence":"first","affiliation":[{"name":"Division of Respirology Department of Paediatrics London Health Sciences Centre Children's Hospital Schulich School of Medicine &amp; Dentistry Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zofia","family":"Zysman\u2010Colman","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine Department of Pediatrics Centre Hospitalier Universitaire Sainte\u2010Justine University of Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-7346","authenticated-orcid":false,"given":"David","family":"Zielinski","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine Department of Pediatrics Montreal Children\u2019s Hospital Montreal Children's Hospital Research Institute McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000465"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-2952C"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.039388"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"60","article-title":"Section 8: muscular dystrophies and home ventilation","volume":"2","author":"Zielinski D","year":"2018","journal-title":"Can J Respir Crit Care Sleep Med"},{"issue":"9","key":"e_1_2_9_6_1","first-page":"1210","article-title":"Forced expiratory technique, directed cough, and autogenic drainage","volume":"52","author":"Fink JB","year":"2007","journal-title":"Respir Care"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1730891"},{"key":"e_1_2_9_8_1","first-page":"162","article-title":"Mechanisms of mucous transport","volume":"127","author":"Warwick WJ","year":"1983","journal-title":"Eur J Respir Dis Suppl"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05250"},{"issue":"4","key":"e_1_2_9_10_1","first-page":"591","article-title":"Respiratory mechanics in quadriplegia. 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