Chronic obstructive airways disease (anaesthesia fitness)

COPD requires intensive preoperative assessment and treatment in order to minimise the risk of postoperative complications.

Assessment includes:

• sputum culture: growth and sensitivity to antibiotics
• peak flow measurement: before and after bronchodilators to determine whether there is a reversible element of airways obstruction
• arterial blood gases: to determine hypoxic or hypercapnic drive
• spirometry:
  • relate to reference values for the same age and height
  • consider cancellation or postoperative transfer to ITU if FVC is less than 2 litres, FEV1 is < 1 litre or FEV1/FVC is less than 0.5
  • poor ventilatory reserve is a good indication of the need for postoperative ventilation

Subsequently, preoperative antibiotics and physiotherapy are provided. Pain relief is particularly important if abdominal surgery is undertaken, e.g. epidural analgesia may be used to permit the patient to cough.