COPD Surgery & Anaesthesia: Managing The Risks 

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. It is currently the fourth leading cause of death in the world.¹ An estimated 3 million people have COPD in the UK, of whom 2 million have undiagnosed COPD.² It is responsible for over 30,000 deaths, 1.4 million General Practitioner consultations, a million hospital bed days and it costs the NHS over £800 million each year.³

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation^1,2,4,5 that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. It includes chronic bronchitis and emphysema.

The most common respiratory symptoms of COPD include dyspnoea, cough and/or sputum production.¹

There is no single diagnostic test for COPD. Making a diagnosis relies on clinical judgement, based on a combination of history, physical examination and confirmation of airflow obstruction using spirometry.^2,4

During assessment, clinicians assess the severity of airflow limitation, the impact of disease on the patient’s health status, and the risk of exacerbations, hospital admissions, or death in order to guide therapy.¹

Classification of COPD depends on FEV1/FVC and FEV1% predicted. NICE, ATS/ERS, and Gold classifications are below:⁵

Treatment of COPD is guided by the severity of lung impairment, symptoms such as dyspnoea, the amount of cough and sputum production, and how often a patient experiences an exacerbation. When dyspnoea limits activity or quality of life, COPD should be treated with once- or twice-daily maintenance long-acting anticholinergic and β-agonist bronchodilators. Patients with acute exacerbations may benefit from the addition of inhaled corticosteroids, particularly those with elevated peripheral eosinophil levels.⁴

A thorough preoperative assessment is crucial in patients with COPD. Assessing the severity of disease will help determine the risk of postoperative complications.⁵

After surgery, patients with severe COPD need close monitoring to avoid respiratory failure or postoperative chest infections. Patients with severe disease or significant co-morbidities should be managed in a high dependency setting capable of regular monitoring of arterial blood gases and providing non-invasive mechanical ventilation if required.⁵

Hypoventilation as a result of residual anaesthesia or opioids should be avoided, as this may lead to hypercarbia and hypoxia. Use of saline nebulization, suctioning, and physiotherapy are useful to avoid sputum plugging and ventilatory failure.⁵

Effective analgesia is a significant determinant of postoperative pulmonary function. Epidural analgesia is a particularly attractive option as it reduces the risk of respiratory failure because of excessive sedation from opioids. It should, therefore, be considered if appropriate to the surgical procedure.⁵

Chronic obstructive pulmonary disease is a complicated disease requiring intensive treatment. When undergoing surgery, patients with COPD, should have regional anaesthesia when possible. When general anaesthesia is required, particular care intra and post operatively focuses on maintaining haemodynamic balance, avoiding respiratory compromise and minimising risk of chest infections. 

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