5. PULMONARY CONCERNS
CHRONIC OBSTRUCTIVE LUNG DISEASE
*COPD/asthma is a major risk factor for the development of post-operative pulmonary complications. As a rule, the risk of pulmonary complications is directly related to the severity of the lung disease AND the proximity of the surgical site to the thorax and diaphragm. Pulmonary function testing has very limited utility in the inpatient pre-operative setting.
1) Bronchodilator therapy with albuterol HHN; add atrovent HHN if emphysematous type lung disease.
2) Inhaled steroids should be continued perioperatively if patient uses this chronically and respiratory status is stable; consider oral or IV steroid therapy if patient has active COPD/asthma pre-operatively or develops exacerbation postoperatively. (Remember to stress dose the steroids if the patient has used oral or IV steroids previously or if the patient is on them by the time of surgery.)
3) Oral theophylline therapy should be continued if patient uses this chronically. If the patient is NPO for an extended period and is dependent on theophylline therapy, then IV aminophylline can be administered until patient is able to resume the PO medication. (For many patients, however, theophylline therapy is of questionable value and can simply be withheld while NPO.)
4) Antibiotics should only be administered if bronchitis or pneumonia is suspected; no use prophylactically for lung disease.
RESTRICTIVE LUNG DISEASE
*The risk of pulmonary complications in patients with restrictive lung disease is unknown, although it appears to be much less than that associated with obstructive disease.
There are no general management recommendations for patients with restrictive lung disease.
Anesthesia should be made aware of underlying restrictive disease, particularly if general anesthesia is employed: tidal volumes should be set lower (with a higher respiratory rate) to avoid high peak pressures.
POSTOPERATIVE PROPHYLACTIC MEASURES IN PATIENTS WITH LUNG DISEASE: