COPD and anaesthesia

COPD and anaesthesia

1. The problem

   • Serious comorbidity
     • Long term mortality of patients with SEVERE COPD having ANY surgery is 47% over 2 years.
     • At risk for serious postoperative complications, esp pulmonary.
   • The solution(s)
     • Preop optimisation, risk identification, and appropriate anaesthetic management.

2. Pathophysiology of COPD

   • Inflammation
     • Inhaled cigarette smoke
       • Airflow limitation that isn't fully reversible
     • Inflammation of small airways - bronchitis/bronchiolitis
       • Plus parenchymal destruction - emphysema
         • Contribution of the two processes varies between individuals.
   • Small airways disease
     • Air trapping and obstruction
       • Chronically and dynamically under stress
         • Affects V/Q mismatching and the loading of the resp muscles
   • Emphysema
     • Decreases gas transfer
       • Reduces the pulmonary capillary bed
         • Worsens the V/Q mismatching
     • Reduces the support of small airways
       • Exaccerbates the small airways disease
   • End result of V/Q mismatching, alveolar hypoventilation, and decreased gas transfer
     • Hypoxia ± hypercarbia
       • Hyperinflation leads to dyspnoea without hypoxaemia
   • Extra pulmonary disease
     • Related to COPD
       • Cor pulmonale
       • Respiratory and skeletal muscle wasting
     • Other
       • CVD that is common in this population