Anesthetic considerations in patients with chronic pulmonary diseases

Increasing age and co-morbidities of patients admitted for surgery impose new challenges on the anesthesiologist.

Review of current literature regarding the perioperative management of patients with chronic pulmonary disease.

If patients are treated adequately, surgery can be safely performed under regional and general anaesthesia. Major risk factors include type of surgery, type and duration of anesthesia, general health status and smoking history, but not certain lung function parameters. Regional anesthesia remains the first choice for intra- and postoperative care, and if general anesthesia is necessary, early extubation should be achieved. Non-invasive ventilation could be a possible alternative in weaning failure.

Assessing the functional status of patients admitted to surgery remains a difficult task, and in patients identified at risk by clinical examination additional spirometry and blood gases may be helpful. If there are signs of respiratory failure, the anaesthetist should monitor the patient closely and invasively, yet there is no reason to deny any patient a substantially beneficial operation.