title: Combined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease.
abstract: BACKGROUND
  The presence of chronic obstructive pulmonary disease (COPD) should not be considered a contraindication to operation but should rather identify those patients that require special preoperative and postoperative pulmonary care. The purpose of this paper is to report our experience in the use of combined spinal and epidural anesthesia (CSEA) for open AAA repair in such patients.
  
  
  METHODS
  From April 1997 to November 1998, three patients with severe COPD underwent elective open infrarenal AAA repair under CSEA. All the patients satisfied one or more of the following criteria: a room air PaO2 =or<60 mmHg, PaCO2 =or>45 mmHg, FEV1 =or<50% of predicted, and/or FVC =or<75% of predicted, and one of them was on home oxygen preoperatively. Preoperative preparation of the patients consisted of breathing exercises with incentive espirometry, elimination of underlaying pulmonary infections and usage of bronchodilator therapy.
  
  
  RESULTS
  All the patients tolerated surgery safely. None of them developed postoperative complications, including pneumonia and other respiratory conditions. No significant changes in room air arterial blood gas or pulmonary function was recognized before and after surgery.
  
  
  CONCLUSIONS
  CSE anesthesia is a viable anesthetic option for conventional AAA surgery in patients with severe COPD since it can preserve spontaneous breathing and provide additional respiratory benefits over general anesthesia.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: J A
authors.initials: JA
authors.lastname: Flores
authors.forename: T
authors.initials: T
authors.lastname: Nishibe
authors.forename: M
authors.initials: M
authors.lastname: Koyama
authors.forename: T
authors.initials: T
authors.lastname: Imai
authors.forename: F
authors.initials: F
authors.lastname: Kudo
authors.forename: K
authors.initials: K
authors.lastname: Miyazaki
authors.forename: K
authors.initials: K
authors.lastname: Yasuda
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D001784:Blood Gas Analysis; D002045:Bupivacaine / Q000008:administration & dosage*; D000075202:Contraindications; D004359:Drug Therapy, Combination; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013748:Tetracaine / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D013748:Tetracaine; D008012:Lidocaine; D002045:Bupivacaine