title: End-stage pulmonary disease and brachial plexus regional anesthesia: their implications on perioperative pulmonary function.
abstract: The authors present the challenging clinical scenario of managing a patient with end-stage chronic obstructive pulmonary disease requiring anesthesia for a proximal humerus open reduction and internal fixation who likely would have failed to wean from mechanical ventilation if general anesthesia and endotracheal intubation had been chosen as the maintenance technique. They discuss the effects of general and regional anesthesia on respiratory physiology and describe the perioperative implications of severe pulmonary disease. They also review the various brachial plexus block options that could achieve a satisfactory outcome, with the objective of helping guide practitioners to a rational choice of anesthetic techniques when caring for patients with end-stage pulmonary disease.
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Maricela
authors.initials: M
authors.lastname: Sanchez
authors.forename: Nisha
authors.initials: N
authors.lastname: Malhotra
authors.forename: Ludwig
authors.initials: L
authors.lastname: Lin
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects; D001917:Brachial Plexus / Q000033:anatomy & histology; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000503:physiopathology; D005541:Forced Expiratory Volume / Q000502:physiology; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000293:injuries; D008168:Lung / Q000502:physiology*; D008171:Lung Diseases / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000150:complications / Q000503:physiopathology; D008297:Male; D059035:Perioperative Period; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests