Is Anesthesia Safe When You Have COPD?

Understanding the Health Risks

Close up of doctor wearing surgical gloves, holding oxygen mask over patient in operating theater
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Are you worried about the risk of anesthesia due to chronic obstructive pulmonary disease (COPD)?

The combination of COPD and anesthesia may carry a significant risk. Long-term survival rates for people with severe COPD who have surgery is often poor.  There is also a significant risk of postoperative complications, especially within the lungs. But does this mean that COPD patients should never have surgery?

Any type of surgery involves risks. Identifying risks early in the preoperative period, preoperative optimization, and appropriate anesthesia management can help lower those risks. Let's take a closer look at what this involves:

Preoperative Risk Identification

Identifying risks early in the preoperative period starts with a thorough history and physical examination. Issues that your doctor may question include:

  • Your established exercise tolerance, especially with climbing hills and stairs.
  • If, and how often, you've developed exacerbations of COPD and if you've ever been hospitalized for them.
  • If you've ever required non-invasive or mechanical ventilation to help you breathe.
  • Your smoking history—both current and former smokers are at greater risk.
  • If you currently have a cough and/or sputum production—both have been associated with a higher risk of post-operative complications.
  • Any other illnesses—understanding co-existing medical conditions (comorbid conditions) is very important in identifying additional risk factors.
  • Whether or not you have signs and symptoms of an active lung infection.
  • Your nutritional status—patients who are both underweight and overweight are at increased risk.

Preoperative Testing

Before having surgery, your doctor may order any or all of the following tests:

  • Chest x-ray - helps to identify current lung infections or additional problems within the lungs.
  • EKG - helps identify heart problems that may increase the risk of surgery.
  • Spirometry - used to both diagnose and determine the severity of COPD.
  • Lung diffusion test - tells your doctor how well oxygen passes from your alveoli to your bloodstream.
  • Six-minute walk test - helps to establish exercise tolerance.
  • Arterial blood gases - helps to identify preoperative oxygen and carbon dioxide levels in the blood.

Preoperative Optimization

Preoperative optimization involves a collaborative effort between you and your doctor and can be divided into the following four categories:

  1. Smoking cessation. Because current smokers have a much greater risk of developing post-operative lung complications from surgery, those who do smoke should quit at least eight weeks prior. If you still smoke, check out this complete guide to smoking cessation.
  2. Drug therapy optimization. Most COPD patients benefit from taking at least one dose of a nebulized bronchodilator before their operation. If you want to brush up on your treatments in this regard, or if you usually use an inhaler instead of a nebulizer, check out this step-by-step guide on how to use a nebulizer to make sure you are getting the full benefit of your treatments. In addition, if you are one of the majority and are trying to remember which medication does what for COPD, check out this information on understanding your bronchodilators.
  1. Treatment for infection and/or exacerbation. Having a lung infection or exacerbation of COPD may contraindicate anesthesia. Contraindicate is simply a fancy way of saying you can't have surgery. Signs and symptoms of active infection should be treated with antibiotics in the period prior to your operation.
  2. Chest physiotherapy. Draining mucus prior to surgery helps remove the excess, which may cause post-operative plugging or pneumonitis. Remind yourself about these five airway clearance techniques and check out this brush-up on clearing mucus with postural drainage.

Managing Risks During Surgery

Your doctor and anesthesiologist will work together to manage the risks associated with anesthesia and COPD during your surgery. The complications listed below are just a few of the complications for which you will be monitored:

Why the Type of Anesthesia Matters

If at all possible, avoiding general anesthesia is optimal for decreasing risks. Talk to your doctor about possible alternatives, such as local or regional anesthesia. Studies have found that people with COPD have a lower risk of pneumonia as well as ventilator dependence if regional anesthesia is used instead of general anesthesia. Shortening the duration of surgery and the length of time you are under general anesthesia, if this is needed, may also be beneficial.

What Are the Possible Complications?

We've talked about lessening risks, and you've probably heard from others that undergoing surgery with COPD is risky, but what exactly could happen?  What, specifically, are those risks? Some people wish to know what could happen, but others would rather not think about it. If you are someone who wishes to know, here are a few things that can occur as complications when people with COPD have surgery with general anesthesia.

  • Lung infections such as pneumonia
  • Sepsis (a "whole body" infection that is very serious)
  • Pneumothorax (a collapsed lung)
  • Respiratory failure
  • Poor wound healing
  • Inability to wean off of mechanical ventilation - For general surgery, a tube is placed into your airway to provide ventilation. A significant concern with lung disease is that the additional stress of surgery on the lungs will make you "ventilator-dependent" even if you were previously breathing OK without assistance.
  • Hypoxia - Tissue damage and cell death due to inadequate oxygenation to the body, including the brain.
  • Blood clots and pulmonary emboli are very common in people with COPD, especially if surgery requires that you be inactive for some time.
  • Cardiac arrest

All COPD patients are at greater risk for developing complications after surgery that involves anesthesia. Active management during each phase of surgical intervention is essential for ensuring an uncomplicated recovery.

Sources:

Cheng Q, Zhang J, Wang H, et al. Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications among PatientsReceiving Bronchoscopic Interventions under General Anesthesia. PLos One. 2015. 10(7):e0130771.

Hausman M, Jewell E, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesthesia and Analgesis. 2015. 120(6):1405-12.<./sub>

Kim H, Lee J, Park Y, et al. Impact of GOLD groups of chronic obstructive disease on surgical complications. International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:281-7.

Kiss G, Claret A, Desbordes J, Porte H. Thoracic epidural anesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anesthesia. Interactive Cardiovascular and Thoracic Surgery. 2014. 19(5):816-23.

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