Chronic Obstructive Lung Disease (COPD)
Considerations
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High risk of perioperative pulmonary complications including respiratory failure
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Physiological changes:
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Mechanical: bronchospasm, mucous plugging, obstructive physiology, bullous disease, pneumothorax, pulmonary tamponade, chronic hypoxemia/hypercarbia
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Cardiovascular: pulmonary hypertension, cor pulmonale
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Etiology & associated co-morbid disease:
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Smoking, coronary artery disease, hypertension, cystic fibrosis, bronchiectasis
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↑ sensitivity to respiratory depressant effects of anesthetic agents
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Medications including recent steroid use
Goals & Conflicts
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Optimization prior to elective procedures:
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Treat bronchospasm, atelectasis, infection, pulmonary edema
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Risk stratify, assess for cor pulmonale
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Intraoperative goals of care:
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Regional/neuraxial anesthesia preferred to GA
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Multimodal analgesia, limit sedative analgesics
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Lung protective ventilation balanced with obstructive lung ventilation strategies:
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Prevent dynamic hyperinflation & barotrauma:
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Long I:E, low peak pressure, low tidal volume, slow rate, permissive hypercapnea
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Maintain normothermia, normal metabolics
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Postoperative disposition including need for PPV & ICU
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Stress dose steroids if indicated
COPD Severity Based on Airflow Obstruction
