ABC's of anesthesia management in chronic obstructive lung disease patients.

1. ABC’s of Management Of Anesthesia
In Chronic Obstructive Pulmonary
Disease Patients
(brief practical review)
Reza Aminnejad; M.D.
Anesthesiologist.

3. In The Name of God

4. 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.

5. 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.

6. 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.

7. 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.