The combination of COPD and anesthesia can be risky business. In fact, the long-term survival rate of COPD patients with severe airway disease who have any type of major surgery is poor. There is also a significant risk of postoperative complications, especially within the lungs. But does this mean that COPD patients should never have surgery?
Any type of surgery involves risks. Identifying risks early in the preoperative period, preoperative optimization and appropriate anesthesia management can help lower those risks. Let's take a closer look at what this involves:
Preoperative Risk Identification
Identifying risks early in the preoperative period starts with a thorough history and physical examination. Issues that your doctor may question include:
- Your established exercise tolerance, especially with climbing hills and stairs.
- If, and how often, you've developed exacerbations of COPD and if you've ever been hospitalized for them.
- If you've ever required non-invasive or mechanical ventilation to help you breathe.
- Your smoking history -- both current and former smokers are at greater risk.
- If you currently have a cough and/or sputum production -- both have been associated with a higher risk of post-operative complications.
- Any other illnesses -- understanding comorbid conditions is very important in identifying additional risk factors.
- Whether or not you have signs and symptoms of an active lung infection.
- Your nutritional status -- patients who are both underweight and overweight are at increased risk.
Before having surgery, your doctor may order any or all of the following tests:
- Chest X-ray -- helps to identify current lung infections or additional problems within the lungs.
- EKG -- helps identify heart problems that may increase the risk of surgery.
- Spirometry -- used to both diagnose and determine the severity of COPD.
- Lung diffusion test-- tells your doctor how well oxygen passes from your alveoli to your bloodstream.
- Six-minute walk test -- helps to establish exercise tolerance.
- Arterial blood gases -- helps to identify preoperative oxygen and carbon dioxide levels in the blood.
Preoperative optimization involves a collaborative effort between you and your doctor and can be divided into the following four categories:
- 1. Smoking cessation. Because current smokers have a much greater risk of developing post-operative lung complications from surgery, those who do smoke should quit at least eight weeks prior.
- 2. Drug therapy optimization. Most COPD patients benefit from taking at least one dose of a nebulized bronchodilator before their operation.
- 3. Treatment for infection and/or exacerbation. Having a lung infection or exacerbation of COPD may contraindicate anesthesia. Signs and symptoms of active infection should be treated with antibiotics in the period prior to your operation.
- 4. Chest physiotherapy. Draining mucus prior to surgery helps remove the excess, which may cause post-operative plugging or pneumonitis.
Managing Risks During Surgery
Your doctor and anesthesiologist will work together to manage the risks associated with anesthesia and COPD during your surgery. The complications listed below are just a few of the complications for which you will be monitored:
If at all possible, avoiding general anesthesia is optimal for decreasing risks associated with postoperative complications for COPD patients. Talk to your doctor about possible alternatives such as local or regional anesthesia. Shortening the duration of surgery and the length of time you are under general anesthesia may also be beneficial.
All COPD patients are at greater risk for developing complications after surgery that involves anesthesia. Active management during each phase of surgical intervention is essential for ensuring an uncomplicated recovery.
Wakatsuki, M. MD & Havelock, T. MD. Anesthesia in Patients with Chronic Obstructive Pulmonary Disease.
Wong, D.H., Weber, E.C., Schell, M.J., Wong, A.B., Anderson, C.T., and Barker, S.J. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. A & A February 1995 Vol. 80. No. 2. 276-284.