ANAESTHESIA AND COPD
ANAESTHESIA AND COPD
Dr PRASHANTHDr GANESHDr KARAN Dr KIRAN
DEFINITIONPATHOPHYSIOLOGYDIAGNOSISPRE OPERATIVE OPTIMISATION
www.goldcopd.com, Updated 2006INTRODUCTION
A common preventable and treatable disease characterised by
persistent airflow limitation that is usually progressive and
associated with an enhanced chronic inflammatory response in the
airways and the lung to noxious particles or gases3rd Leading cause
of morbidity & mortality
3
COPD INCLUDES..CHRONIC BRONCHITIS: (clinical definition) Chronic
productive cough for 3 months in each of 2 successive years
EMPHYSEMA: (anatomical definition) Permanent enlargement of the
airspaces distal to the terminal bronchioles
SMALL AIRWAY DISEASE: Narrowing of small bronchioles due to
hyperplasia, mucus and fibrosis
Comparative features of COPDFeatureChronic
BronchitisEmphysemaMech of Airway ObstructionDecreased Lumen d/t
mucus & inflammationLoss of elastic
recoilDyspnoeaModerateSevereFEV1 DecreasedDecreasedPaO2 Marked
Decrease (Blue Bloater)Moderate Decrease (Pink Puffer)PaCO2
IncreasedNormal or DecreasedDiffusing
capacityNormalDecreasedHematocritIncreasedNormalCor
PulmonaleMarkedMildPrognosisPoorGood
Differences Between COPD and AsthmaParameters COPD Asthma Onset
Middle ageEarly in life (often childhood) SymptomsSlowly
progressive Diurnal and seasonal variationHistory Long smoking
history or exposure to smoking and bio-mass fuel History of
allergy, rhinitis and/or eczema. Inflammatory cells Neutrophils
Eosinophils Airway hyperresponsiveness ++++++Airflow limitation
Largely irreversible usually < 15% or 200 ml change Largely
reversible usually > 15% or 200 ml change. (irreversible in
later stages)
Risk factorsSMOKE: CIGARETTE smoking passive smoking
environmental occupational Genetic factors: 1 anti trypsin
deficiency
PATHOGENESIS
PATOGENESIS contd..Elastase & antielastase hypothesis
Imbalance between elastin and elastase Deficiency of 1 antitrypsin
which is elastase inhibitor Autoimmune contributionCigarette smoke
induced loss of cilia & impaired macrophage phagocytosis
PATOGENESIS contd..
PATHOLOGY contd..
Types of emphysema
PATHOPHYSILOGY :PULMONARY
PULMONARYAIRWAY OBSTUCTIONHYPERRESPONSIVENESSALVEOLAR
DESTRUCTIONSECRETIONSHYPERINFATION
PATHOPHYSIOLOGY contd..:EXTRA PULMONARY
IL6,TNF a, CRP, OXIDANTS, HYPOXEMIART HEART DISEASE,IHDSKELETAL
MUSCLE WEAKNESSOSTEOPOROSISDM, DEPRESSION
PATHOPHYSIOLOGY contd..:EXTRA PULMONARY
PRE OPERATIVE OPTMISATION
Pre-operative assessment:History:SmokingCough: Type,
Progression, Recent RTISputum: Quantity, color,
bloodDyspneaExercise intoleranceOccupation, AllergiesSymptoms of
cardiac or respiratory failure
Physical findingsEarly stage: signs of smokingAdvanced stage:
prolonged expiratory phase with wheezeSigns of hyperinflation:
barrel chestUse of accessory musclesTripod
positionCyanosisCachexia, bitemporal wasting & diffuse loss of
subcutaneous adipose tissueClubbing : ?? carcinoma
PHYSICAL FINDINGS contd..Pink puffers emphysema Thin patients
Non cyanotic at rest Use of accessory muscles Good prognosisBlue
bloaters Chronic bronchitis Heavy patients Cyanotic at rest Bad
prognosis
Investigations:Routine blood investigations Chest Radiograph: To
exclude other diseasesEmphysematous
changesSpirometryDiagnosisAssessment of severityFollowing
progressBronchodilator ReversibilityExclude Bronchial Asthma 70
years
Bed side PFTSabrasez breath holding test:>25 sec- normal
cardio pulmonary reserve (CPR)15-25 sec- limited CPR150L/min 6
>60 L/min 3 >40L/min
Match blowing test
Bed side PFT contd..Cough test: deep breath followed by cough
Ability to cough Strength Effectiveness Inadequate cough : FVC 2Age
>70 yearsNeck, thoracic, upper abdominal, aortic, or neurologic
surgeryAnticipated prolonged procedures (>2 hours) General
anesthesia (especially with endotracheal intubationAlbumin less
than 3g/dLExercise capacity of less than two blocks or one flight
of stairsBMI greater than 30Arozullah AM, Ann Surg
232:242-253,2000.
Risk factors for post op pulmonary complications
To be contd.....
Thank you
