The World Health Organization (WHO) defines chronic obstructive pulmonary disease (COPD) as “a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.”1 A COPD diagnosis is confirmed by a test called spirometry, which measures how deeply a person can breathe and how fast air can move in and out of the lungs.1 COPD currently affects 65 million people and is the fourth leading cause of death across the world.2 Additionally, 40 percent of all COPD-related deaths are related to tobacco smoking, and the burden of COPD is projected to grow even further over the coming years.3 Because it affects many of the world’s patients, COPD is an important factor in all types of medical care. In particular, anesthesiologists must be cautious with patients with COPD given their higher risk of pulmonary complications.4 Since general anesthesia can reduce patients’ ability to breath on their own,5 patients with COPD must be monitored closely before, during and after surgery to prevent issues.4
Researchers have been investigating surgical and anesthetic risks in patients with COPD for more than 40 years.6 Recent studies have approached anesthesiologists’ perioperative (i.e., before, during and after surgery) treatment of patients with COPD. For example, Stucki and Bollinger recommend that patients with COPD cease smoking tobacco at least eight weeks before surgery and—if indicated—have preoperative treatment with antibiotics, beta2-agonists (bronchodilators), steroids and intensive chest physiotherapy.7 Also, a study by Edrich and Sadovnikoff showed that optimal preparation for surgery for patients with COPD included treatment of reversible airway obstruction and respiratory infections, smoking cessation and nutritional interventions.8 Nakazato and Takeda found that smoking cessation four to eight weeks before surgery, as well as preoperative instruction on inspiratory muscle training, decreased risk of postoperative pulmonary complications (PPCs).9 Finally, Numata et al. suggest it is possible to reduce PPCs by implementing formal preoperative pulmonary management in hospitals, including pre-procedure medical evaluation by a pulmonologist and medical treatment.10 Thus, preparation for anesthesia for a patient with COPD can be effective in preventing post-surgery complications.
Even with adequate preoperative preparation, patients with COPD are still at high risk for pulmonary complications during and after surgery. During surgery, anesthesiologists must consider the effects of general anesthesia on the respiratory system before administering any type of anesthetic drug. Recently, many studies have shown that regional or epidural anesthesia may be more appropriate than general anesthesia for patients with COPD.7,11-13 For example, one study found that use of regional versus general anesthesia in patients with COPD was associated with lower incidences of respiratory complications such as pneumonia, prolonged ventilator dependence and unplanned postoperative intubation.14 Other studies showed that regional anesthesia was effective in abdominal surgery4 and cholecystectomy (i.e., gallbladder removal)11 for patients with COPD. Regardless of anesthesia type, anesthesiology practitioners must meticulously monitor patients with COPD and understand the mechanisms of a patient’s breathing throughout surgery.8,15 After surgery, anesthesia providers must consider the use of anesthetic drugs, such as epidural anesthesia, for pain management. Many studies have found epidural anesthesia to have no harmful respiratory effects for postoperative pain management in patients with COPD; but other studies have shown reduced lung function.16 Overall, anesthesiology practitioners need to choose carefully the types of anesthesia administered during and after surgery.
Because of the relationship between anesthesia and respiratory depression, pulmonary diseases such as COPD can cause high risk of complications during and after procedures. It is the anesthesia provider’s responsibility to prepare a patient with COPD for surgery with medication and lifestyle changes, monitor the patient’s breathing throughout a procedure and provide the proper anesthesia during and after surgery. Future research should examine the benefits of regional anesthesia for patients with COPD and investigate ways to reduce risk of complications, such as smoking cessation or medical treatment before surgery.
1. World Health Organization. COPD: Definition. Chronic respiratory diseases 2019; https://www.who.int/respiratory/copd/definition/en/.
2. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. Journal of Global Health. 2015;5(2):020415.
3. World Health Organization. Burden of COPD. Chronic respiratory diseases 2019; https://www.who.int/respiratory/copd/definition/en/.
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5. Mayo Clinic. General anesthesia. 2019; https://www.mayoclinic.org/tests-procedures/anesthesia/about/pac-20384568.
6. Tarhan S, Moffitt EA, Sessler AD, Douglas WW, Taylor WF. Risk of anesthesia and surgery in patients with chronic bronchitis and chronic obstructive pulmonary disease. Surgery. 1973;74(5):720–726.
7. Stucki A, Bolliger CT. Evaluation of surgical risk in patients with COPD. Therapeutische Umschau. Revue therapeutique. 1999;56(3):151–156.
8. Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Current Opinion in Anesthesiology. 2010;23(1):18–24.
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14. Hausman MSJ, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesthesia & Analgesia. 2015;120(6):1405–1412.
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16. Unic-Stojanovic D, Babic S, Jovic M. Benefits, risks and complications of perioperative use of epidural anesthesia. Medical Archives. 2012;66(5):340.