183289
COPD and anaesthesia
- The problem
- Serious comorbidity
- Long term mortality of patients with
SEVERE COPD having ANY surgery is
47% over 2 years.
- At risk for serious
postoperative
complications, esp
pulmonary.
- Long term mortality of patients with
SEVERE COPD having ANY surgery is
47% over 2 years.
- The solution(s)
- Preop optimisation, risk
identification, and
appropriate anaesthetic
management.
- Preop optimisation, risk
identification, and
appropriate anaesthetic
management.
- Serious comorbidity
- Pathophysiology of COPD
- Inflammation
- Inhaled cigarette smoke
- Airflow limitation that
isn't fully reversible
- Airflow limitation that
isn't fully reversible
- Inflammation of small
airways -
bronchitis/bronchiolitis
- Plus parenchymal
destruction - emphysema
Nota:
- Contribution of the two processes varies between individuals.
- Plus parenchymal
destruction - emphysema
- Inhaled cigarette smoke
- Small airways disease
- Air trapping and
obstruction
- Chronically and
dynamically under
stress
- Affects V/Q mismatching
and the loading of the resp
muscles
- Affects V/Q mismatching
and the loading of the resp
muscles
- Chronically and
dynamically under
stress
- Air trapping and
obstruction
- Emphysema
- Decreases gas transfer
- Reduces the
pulmonary
capillary bed
- Worsens the
V/Q
mismatching
- Worsens the
V/Q
mismatching
- Reduces the
pulmonary
capillary bed
- Reduces the support
of small airways
- Exaccerbates
the small airways
disease
- Exaccerbates
the small airways
disease
- Decreases gas transfer
- End result of V/Q
mismatching, alveolar
hypoventilation, and
decreased gas transfer
- Hypoxia ± hypercarbia
- Hyperinflation leads to
dyspnoea without
hypoxaemia
- Hyperinflation leads to
dyspnoea without
hypoxaemia
- Hypoxia ± hypercarbia
- Extra pulmonary disease
- Related to COPD
- Cor pulmonale
- Respiratory and
skeletal muscle
wasting
- Cor pulmonale
- Other
- CVD that is
common in this
population
- CVD that is
common in this
population
- Related to COPD
- Inflammation
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