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Saturday, December 7, 2013
C.O.P.D. and anesthesia
I need surgery to either improve my right kidney flow (Pelvo-ureteric junction obstruction) or possibly remove it. I have C.O.P.D and use a salbutamol inhaler occasionally. Is it possible for me to have anaesthesia safely - or is it possible for the surgery to be carried out with local anaesthesia?
Upper abdominal surgery - like kidney surgery - causes a decrease in lung function afterward. A person whose lung function is very poor can almost always get through the operation itself without any major breathing problems. The difficulties arise after the procedure, and will depend on how much "reserve" you have. This in turn requires an estimate of the severity of lung disease that you have. Persons with severe lung disease are breathless with minimal exertion or even at rest, have had to be in hospital one or more times for respiratory problems, regularly use medications like inhalers, antibiotics, theophylline and steroids, and may have to use oxygen at night or all through the day. Preoperative tests can help a little bit, but are notoriously inaccurate in predicting which people will do badly after abdominal surgery. Local anesthesia is not usually an option.
The main thing is to make sure that you are at your best before elective surgery. This means good nutrition and hydration, avoiding or treating any respiratory infection, using inhalers on a regular basis, and making sure other problems like diabetes or high blood pressure are properly treated. It goes without saying that you should quit smoking. So-called incentive spirometry may help after surgery to re-expand the lungs, small areas of which tend to collapse after general anesthesia and this type of surgery.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University