Chronic Obstructive Lung Disease (COPD)

 

 

Considerations

 

  • High risk of perioperative pulmonary complications including respiratory failure

  • Physiological changes:

    • Mechanical: bronchospasm, mucous plugging, obstructive physiology, bullous disease, pneumothorax, pulmonary tamponade, chronic hypoxemia/hypercarbia

    • Cardiovascular: pulmonary hypertension, cor pulmonale

  • Etiology & associated co-morbid disease:

    • Smoking, coronary artery disease, hypertension, cystic fibrosis, bronchiectasis

  • ↑ sensitivity to respiratory depressant effects of anesthetic agents

  • Medications including recent steroid use

 

 

Goals & Conflicts

 

  • Optimization prior to elective procedures:

    • Treat bronchospasm, atelectasis, infection, pulmonary edema

    • Risk stratify, assess for cor pulmonale

  • Intraoperative goals of care:

    • Regional/neuraxial anesthesia preferred to GA

    • Multimodal analgesia, limit sedative analgesics

    • Lung protective ventilation balanced with obstructive lung ventilation strategies:

      • ​Prevent dynamic hyperinflation & barotrauma:

        • ​Long I:E, low peak pressure, low tidal volume, slow rate, permissive hypercapnea

    • Maintain normothermia, normal metabolics

  • Postoperative disposition including need for PPV & ICU

  • Stress dose steroids if indicated 

 

 

COPD Severity Based on Airflow Obstruction