Criteria of fitness for anaesthesia in patients with chronic obstructive lung disease.

Abstract

Twelve patients with severe chronic obstructive lung disease undergoing 15 operations were assessed with preoperative lung function tests and blood gas estimations. Their operative and postoperative course was followed. There were no deaths or serious complications. Patients fell into three groups: those with low respiratory capacity but normal blood gases, who required no special respiratory treatment apart from physiotherapy and antibiotics; those with hypoxaemia but normal arterial carbon dioxide pressure, who needed more prolonged oxygen treatment after operation; and those with hypoxaemia and hypercapnia, who needed postoperative ventilatory support. While forced expiratory volume in one second (FEV,) is a good screening test in preoperative assessment it should be supplemented by arterial blood gas estimations in patients with an FEV, of less than 1 litre.

Epidural anesthesia and pulmonary function

“…Airway instrumentation in patients with increased bronchial reactivity can cause markedly increased rates of intraoperative bronchospasm, and even lifethreatening complications postoperatively [55,[58][59][60]. The effect of endotracheal intubation even in symptomfree asthmatics was demonstrated in a study of volunteers with mild asthma [61].…”

Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media

“…It is important to emphasize that a relevant but 'stable' reduction in FEV 1 values with a low degree of reversibility of airway obstruction, do not imply an absolute contraindication to surgical procedures, including those involving endotracheal intubation 50 . It has been shown that the most important risk factor for perioperative bronchospasm is a high degree of bronchial hyperreactivity not adequately controlled by long-term anti-inflammatory treatment and the consequent airway instability 12,35 .…”

Preoperative Evaluation of Lung Cancer Patients

“…Arterial blood gases are usually analyzed at the time of D LCO measurement or cardio-pulmonary exercise testing. A landmark cohort study in the mid-1970s showed that preoperative hypercapnia was associated with prolonged postoperative ventilation [34]. More recent studies have failed to identify impaired CO 2 clearance as a risk factor for unplanned admission to the ICU or need for mechanical ventilator support after nonthoracic surgery [35].…”