Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

Abstract

Patients with chronic obstructive pulmonary disease (COPD) exhibit airflow limitation and suboptimal lung function, and they are at high risk of developing postoperative pulmonary complications (PPCs). We aimed to determine the factors that would decrease PPC risk in patients with COPD. We retrospectively analyzed 419 patients with COPD who were registered in our institutional PPC database and had undergone an abdominal surgery under general anesthesia. PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm; the presence or type of PPC was diagnosed by respiratory physicians and recorded in the database before this study. Binary logistic regression was used for statistical analysis. Of the 419 patients, 121 patients (28.8%) experienced 200 PPCs. Multivariable analysis showed three modifiable anesthetic factors that could decrease PPC risk: low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced neuromuscular blockade reversal. We found that the 90-day mortality risk was significantly greater in patients with PPC than in those without PPC (5.8% vs. 1.3%; p = 0.016). Therefore, PPC risk in patients with COPD can be decreased if low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced reversal during abdominal surgery are efficiently managed, as these factors result in decreased postoperative mortality.

The Strategy to Use Sugammadex to Reduce Postoperative Pulmonary Complications after da Vinci Surgery: A Retrospective Study

“…According to a meta-analysis, restricted fluid infusion can decrease PCC risk in patients with COPD [17]. PPC risk increases by approximately 10% with every 1 mL/kg/h increase in fluid infusion, mainly due to respiratory failure and pleural effusion.…”

Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial

“…4 The risk of postoperative pulmonary complications also increases as aging proceeds because of the declined function of swallowing and sputum excretion. 5,6…”

“…4 The risk of postoperative pulmonary complications also increases as aging proceeds because of the declined function of swallowing and sputum excretion. 5,6 Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to reduce postoperative complications, shorten length of hospitalization, and accelerate surgical recovery. 7 Prehabilitation programs, as core intervention strategies of ERAS, were developed to increase patients' functional capacity reserve, prevent cardiovascular disease, and improve pulmonary function by physical activity before surgery.…”

Longer time to extubation after general anesthesia with desflurane in patients with obstructive respiratory dysfunction: a retrospective study

“…Because patients with COPD are known to be at high risk of developing postoperative pulmonary complications [1], careful perioperative management should be performed for patients with obstructive respiratory dysfunction. It is particularly important to wake the patient from anesthesia promptly after surgery to avoid deterioration of postoperative pulmonary function.…”