title: The role of exhaled nitric oxide in patients with chronic obstructive pulmonary disease undergoing laparotomy surgery - The noxious study.
abstract: Chronic Obstructive Pulmonary Disease (COPD) has been associated with major perioperative morbidities or mortalities, especially in surgical patients receiving general anesthesia. The severity of the COPD and the degree of bronchial hyperreactivity can determine the perioperative anesthetic risk; therefore they have to be assessed by a thorough preoperative evaluation in order to give the rationale on which to decide for optimum anesthetic management.
  
  
  
  Aim of the study was to assess the predictive applicability of exhaled Nitric Oxide (NO) in smoking surgical population with COPD, on the basis of morbidity and mortality.
  
  
  
  A prospective, observational study was undertaken in 70 smoking patients diagnosed with COPD scheduled for laparotomy surgery under general anesthesia COPD was evaluated with the GOLD Classification of Air Flow Limitation, the Modified MRC Dyspnoea Scale (mMRC), the BODE Index score and the 6 Minutes Walk Distance (6MWD) using spirometry parameters. All patients were observed for presenting perioperative and postoperative respiratory complications. A cut off value of 19 ppb was determined for fractional exhaled nitric oxide measured at expiratory flow of 50 mL/s (FENO50) to differentiate patients poor prognosis from those with favorable outcome.
  
  
  
  Patients with severe COPD had high BODE index score as well as FENO50. Elevated FENO50is significantly related to multiple complications (p = 0.004) and postoperative cough (p < 0.001). Patients from the high FENO50group that were not treated with steroids had a statistically significant higher incidence of extra hospital care need (p < 0.001). Increased FENO50and ABCD classification are both related with the presentation of multiple complications (Odds ratio = 2.5, 95% CI 1.1 to 5.7, p = 0.028 for ABCD and Odds ratio = 6.39, 95% CI 1.33 to 30.5, p = 0.020 for FENO50). Increased FENO50and ABCD are related with extra hospital care (p = 0.001 and p = 0.002 respectively) and combined with corticosteroid administration could predict the necessity for extra hospital care (Odds ratio 4.09, 95% CI 1.1 to 15.3, p = 0.036 for corticosteroid treatment, odds ratio 2.4, 95% CI 1.1 to 5.1, p = 0.029 for ABCD and odds ratio 7.93, 95% CI 1.7 to 35.3, p = 0.007 for FENO50).
  
  
  
  The FENO50may identify high risk smoking surgical patients with COPD receiving general anesthesia. Perioperative and postoperative complications in COPD smoking patients undergoing abdominal surgery can be predicted using not only ABCD GOLD 2011 classification but also the FENO50as a preoperative marker.
authors: Department of Anesthesiology, Achillopouleion General Hospital of Volos, Magnesia, Greece.
authors: Helena
authors: H
authors: Logotheti
authors: 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Greece; Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece. Electronic address: chpour@gmail.com.
authors: Chryssa
authors: C
authors: Pourzitaki
authors: Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece.
authors: Georgia
authors: G
authors: Tsaousi
authors: Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece.
authors: Zoi
authors: Z
authors: Aidoni
authors: Department of Anesthesiology, Achillopouleion General Hospital of Volos, Magnesia, Greece.
authors: Artemis
authors: A
authors: Vekrakou
authors: Clinic of Anesthesiology and Intensive Care, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece.
authors: Amaniti
authors: A
authors: Ekaterini
authors: Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece.
authors: Konstantinos
authors: K
authors: Gourgoulianis
mesh_terms: D000005:Abdomen / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D001944:Breath Tests; D045853:Exhalation; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000378:metabolism*
chemical_list: D000305:Adrenal Cortex Hormones; D009569:Nitric Oxide
keywords: Chronic obstructive pulmonary disease (COPD); Complications; Corticosteroids; Exhaled nitric oxide; F(E)NO(50); Smoking; Surgery