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Department of Anesthesiology
Faculty of Medicine
Atma Jaya Catholic University
Effects of Anesthesia on
Respiratory Physiology
• Reduction of Oxygen
Consumption and Carbon
Dioxide Production by 15%
• Especially in Heart and Brain
• Hypothermia accentuated this
effect
Effects on Respiratory
Pattern
Resistance to airflow
• Early Abnormality : MMEF
(FEF25-75%) <70%
Late course :
• FEV1 <70% predicted
• FEV1/FVC <70% predicted
Obstructive Pulmonary
Disease
Obstructive Pulmonary
Disease
Clinical Significance :
• Elevated airway resistance & air
trappingincreased work of
breathing
• Impaired respiratory gas
exchange due to
Ventilation/Perfusion (V/Q)
imbalance
Obstructive Pulmonary
Disease
Obstructive Pulmonary
Disease
Asthma
Preoperative Considerations
• Common disorder; 5-7%
populations
• Bronchiolar inflammation &
hyperreactivity in response to
various stimulation.
• Trigger :
Airborne, Ingestion, Exercise,
Emotional, Viral
• Intermittent (mild), Moderate,
Persistent (severe)
Asthma
Pathophysiology
Chemical mediators
• Smoking history:
– Always 2 questions
• Do you smoke?
• Have you ever smoked / when did you quit?
– PPD and duration
• Dyspnea: presence, severity, exercise tolerance,
home O2 requirement, baseline SpO2 on room air
• Productive cough: how often, fever?
• Wheezing: how often, reversible?
• Admissions to hospital / ER: intubated?, length?,
prolonged ventilation? infection?
• PSHx
Preop studies for COPD
• FEV1 < 2L
• FEV1/FVC < 0.5
• VC < 15cc/Kg in
adult & < 10cc/Kg
in child
• VC < 40 to 50%
than predicted
Signs and Symptoms of
Chronic Obstructive
Pulmonary Disease
• Progressive dyspnea
• Variable cough
• Destruction of elastic and collagen network of alveolar walls
without fibrosis leads to abnormal enlargement of air spaces
• Loss of airway support leads to airway narrowing and collapse
during exhalation – air trapping
• Loss of pulmonary elastic recoil
• “Pink-puffers”
• Causes: Smoking, coal miners, alpha-1 antitrypsin deficiency
= autodigestion of pulmonary tissue by proteases
Pink-puffers
preoperative interventions in
patients with COPD :
•correcting hypoxemia
•relieving bronchospasm
•mobilizing and reducing
secretions
•treating infections
• Ventilator adjustments
– Severe emphysema requires longer expiratory times (normal I:E is 1:2,
so in COPD 1:3)
– Closely monitor peak inspiratory pressures (PIP) to avoid rupturing an
emphysematous bleb or bullae, PTX
– CO2 retainers: EtCO2 should be keep near the pt’s baseline, a rapid
correction will lead to metabolic alkalosis
• Large gradient between EtCO2 & PaCO2
• N2O may expand bullae, worsens pulmonary HTN
COPD Intraoperatively
• Airway stimulation with light anesthesia – DES, ISO
• A-line to monitor ABG’s
• Laryngospasm due to secretions – suction ETT frequently
• Mucociliary clearance worsened after inhalation agents
• Bronchospasm: avoid *histamine releasing drugs
– Pentothal (STP), Morphine (MSO4), Atracurium, Mivacurium,
Neostigmine
– Tx with nebulized albuterol especially before extubation
Regional anesthesia and
COPD