J Korean Med Assoc.  2020 Sep;63(9):532-539. 10.5124/jkma.2020.63.9.532.

Anesthetic management of patients with chronic obstructive pulmonary disease

Affiliations
  • 1Department of Anesthesia and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide. It has a prevalence of 14% among Koreans aged above 40 years and a prevalence of 31% among those aged above 65 years. However, only 6% of the COPD patients receive treatment. Most of the patients do not seek medical attention, as they think that dyspnea, cough, and productive sputum, which are the common symptoms of COPD, are normal aging phenomena. Smoking is a major risk factor for COPD, but environmental hazards and genetic susceptibility are also involved. With aging, lung injuries due to these risk factors accumulate, leading to increased prevalence of COPD. The major concerns regarding perioperative management of COPD patients include preoperative evaluation of cardiopulmonary risks, optimization of lung function, and evaluation of COPD-related physiological functions that are easily aggravated during anesthesia. These include respiratory muscle dysfunction, dynamic hyperinflation and auto-positive end-expiratory pressure, hypoxia-hypercarbia, and pulmonary hypertension-associated heart failure. Therefore, anesthesia for COPD patients should focus on preoperative evaluation, risk reduction measures, and prevention of postoperative pulmonary complications.

Keyword

Anesthesia; Chronic obstructive pulmonary disease; Postoperative complications; Perioperative care; 마취; 만성폐쇄성폐질환; 수술후합병증; 수술전후기관리
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