Is Anesthesia Safe When You Have COPD?

Close up of doctor wearing surgical gloves, holding oxygen mask over patient in operating theater
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Chronic obstructive pulmonary disease (COPD), increases the chances of surgical complications, such as infections and respiratory crises. In preparation for any surgical procedure, a pre-operative evaluation includes screening for lung disease. If you have signs of COPD, you will need further pulmonary tests, and your surgical plan may involve strategies such as modified anesthesia.

After surgery, COPD can lead to prolonged recovery, so your medical team will closely monitor you for possible post-operative lung complications.

Any type of procedure involves weighing the risks and benefits, but COPD amplifies the risk of surgery and anesthesia. Long-term survival rates for people with severe COPD who have surgery are lower than that of people who do not have COPD.

Identifying risks early in the preoperative period, preoperative optimization, and appropriate anesthesia management can help improve your chances for a healthy recovery. If your lungs are severely impaired, your risk may be considered too high—and your doctors may recommend that you avoid surgery altogether.

Risk Identification

Identifying risks early in the preoperative period starts with a thorough history and physical examination. The following COPD associated factors increase your risk of surgical and post-operative problems.

  • Your exercise tolerance, especially with climbing stairs or walking uphill.
  • If, and how often, you've developed COPD exacerbations 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.
  • Whether you have signs and symptoms of an active lung infection.
  • Your nutritional status—being underweight or overweight increase the risk.
  • Any other medical illnesses.

Preoperative Planning

Typically, before surgery, you will need a pre-operative evaluation. This phase includes screening for health issues that may need to be corrected before surgery (such as a low red blood cell count) or problems that may necessitate postponing surgery (such as a major infection.)

With COPD, your pre-operative planning includes additional tests that evaluate respiratory function. And there are also a number of things you may need to do to prepare—such as taking medication to decrease mucus or not smoking—in the days and weeks before your procedure.

Testing

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

  • 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 is used to 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 is a reflection of your exercise tolerance, which relies partially on your lung function.
  • Arterial blood gases help to identify preoperative oxygen and carbon dioxide levels in the blood.

Optimization

Preoperative optimization involves a collaborative effort between you and your doctor to improve your COPD associated health issues before you have surgery. This will increase your tolerance for anesthesia and help prevent common post-surgical issues (such as pneumonia).

Steps you may need before surgery include:

  • Smoking cessation: Because smokers who have COPD have a much greater risk of developing postoperative 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.
  • Drug therapy optimization: Your doctor might recommend that you take at least one dose of a nebulized bronchodilator before your operation. You can learn how to use a nebulizer if you do not usually use this type of treatment.
  • Treatment for infection and/or exacerbation: Signs and symptoms of active infection may be treated with antibiotics in the period prior to your operation, and in some cases, your doctor may delay your procedure until you have fully recovered.
  • Chest physiotherapy. Draining mucus prior to surgery helps remove the excess, which may cause post-operative plugging or pneumonitis. Your doctor may recommend airway clearance techniques or clearing mucus with postural drainage.

Managing Risks During Surgery

Your surgeon and anesthesiologist will work together to manage the risks that could occur during surgery.

Surgical risks when you have COPD, include:

Adapting Your Procedure

Your doctors may discuss shortening the duration of your surgery and the length of time you are under general anesthesia. This could mean that you would only have a short procedure—for example, you may have one knee replaced instead of both.

If you are having a cosmetic procedure, your medical team may recommend a less extensive surgery to avoid prolonged anesthesia and extensive surgical healing—both of which can be complicated when you have COPD.

Type of Anesthesia

Your doctors may discuss the option of avoiding general anesthesia if possible. Major procedures (like heart surgery or vascular surgery) necessitate general anesthesia, but some procedures (like eye surgery) can be possible with 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.

Complications During Recovery

After your surgery, you might not be completely out of the woods. Issues can arise days or weeks after surgery, so your medical team will want to make sure that you are having a full recovery before giving you the green light to resume activities.

Anesthesia Associated Complications

The inability to wean off mechanical ventilation can occur when you have COPD. With general anesthesia, 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.

Recovering from anesthesia involves a process by which your lungs start to function independently again after relying on a machine for a few hours. This is more difficult when you have COPD.

Post Surgical Complications

Even if you did not have general anesthesia, it takes at least day (or weeks with a major surgery) to recover after lying still and having an incision with a wound.

Postoperative complications that are more likely when you have COPD include:

  • Lung infections such as pneumonia
  • Sepsis (a whole-body infection that is very serious)
  • Pneumothorax (a collapsed lung)
  • Respiratory failure
  • Slow or impaired wound healing
  • Hypoxia, which is 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 the surgery requires that you be inactive for a prolonged period of time.
  • Cardiac arrest

You may have your breathing, heart rate, oxygen level, and carbon dioxide monitored during your recovery. Your doctors will check your legs to watch for blood clots, and closely monitor your wound as you recover.

A Word From Verywell

When you have COPD, it can increase the risk of other health issues, including surgical complications. Because these risks are known, there are tests your medical team can use to assess your respiratory function and steps you and your doctors can take to reduce the risk of complications during and after your surgery.

Once you have recovered after surgery, be sure to maintain close follow up of your pulmonary condition so that you can take medications and adopt lifestyle methods to slow the progression of your COPD.

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Article Sources

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