ABC’s of Management Of Anesthesia In Chronic

Obstructive Pulmonary Disease Patients

(brief practical review)

Reza Aminnejad; M.D.Anesthesiologist.

In The Name of God

Intraoperative Management

The choice of anesthetic technique or specific anesthetic drugs does not seem to alter the incidence of postoperative pulmonary complications.

Some suggest that operations lasting longer than 3 hours are more likely to be associated with postoperative pulmonary complications (Controversial).

Continued tracheal intubation and mechanical ventilation may be necessary, particularly after upper abdominal or intrathoracic surgery.

RA in COPD Patients It must be appreciated that COPD

patients can be extremely sensitive to the ventilatory depressant effects of sedative drugs.

Regional anesthetic techniques that produce sensory anesthesia above T6 are not recommended.

GA in COPD Patients Volatile anesthetics are useful because of the

ability of these drugs (especially desflurane and sevoflurane) to be rapidly eliminated through the lungs.

N2O should be avoided in the presence of pulmonary bullae.

Large tidal volumes (10–15 mL/kg) combined with slow inspiratory flow rates (6-10 bpm) minimize the likelihood of turbulent airflow and help maintain optimal ventilation-to-perfusion matching; this pattern is as efficacious as PEEP.

Postoperative Considerations Lung expansion maneuvers (deep breathing

exercises, incentive spirometry, chest physiotherapy, positive-pressure breathing techniques)

Postoperative neuraxial analgesia with opioids may permit early tracheal extubation.

Patients with preoperative FEV1/FVC ratios less than 0.5 or with a preoperative PaCO2 of more than 50 mm Hg are likely to need some postoperative mechanical ventilation.

Chest Physiotherapy should be in mind.