Anesthesia for patients with severe chronic obstructive pulmonary disease.
OBJECTIVE
Patients with chronic obstructive lung disease experience an increased risk of perioperative pulmonary complications. This review presents an evidence-based approach to perioperative care designed to optimize management.


RESULTS
Recent research has provided guidance regarding intraoperative and postoperative administration of oxygen and the selective use of volatile agents. The significance of preoperative malnutrition and postoperative epidural analgesia on outcomes has also been explored further. The opportunity for anesthesiologists to engage in tobacco interventions and the benefits of addressing smoking cessation have been studied.


CONCLUSIONS
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.
Edrich
Thomas
T
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. tedrich@partners.org
Sadovnikoff
Nicholas
N
D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000768:Anesthesia, General / Q000379:methods*; D000776:Anesthesiology / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D016343:Monitoring, Intraoperative; D011300:Preoperative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology