Anesthesia for patients with chronic obstructive pulmonary disease

Description

COPD presents a challenge to the anesthesiologist.The long term survival of patients with severe COPD undergoing any type of surgery is poor  and they are at significant risk of postoperative pulmonary complications. However with risk identification, pre-operative optimisation and appropriate anaesthetic management, the risks of developing postoperative pulmonary complications can be reduced even in patients with severe disease. Patients with COPD vary in their presentation - from the asymptomatic and undiagnosed to those with a severely disabling systemic disease. All COPD patients benefit from active management throughout the pre-, intra- and post-operative phases. Chest physiotherapy, including respiratory muscle training and smoking cessation, can reduce threats in high-risk patients. Optimization for surgery includes preoperative treatment of reversible airway obstruction and respiratory infections, smoking cessation, and possibly nutritional interventions. Meticulous intraoperative monitoring combined with a sound understanding of pathophysiological mechanisms underlying air trapping will help clinicians strike a balance between permissive hypercapnia and adequate ventilation.