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Sunday, December 8, 2013
Surgery, Anethesia and COPD
My mother-in-law has COPD. She is not on supplemental oxygen and takes 3-4 breathing tx per day using her home nebulizer. She does not exhibit labored wob in her daily activities. Her physician does not require her to check her O2 sats with a pulse ox at home. When I asked her what her O2 Sat was when she went to the dr, she said it was 80. Wouldn`t she be on oxygen if her O2 sats were consistantly at 80%?
She also says that she has a back condition that could be repaired with surgery but has told her sons and myself that she cannot have any surgeries under any circumstances because of the severity of her COPD. I find this hard to believe since her lung function does not require the use of addtional oxygen nor exhibiting labored wob while walking or doing chores around her home.
How bad would a COPD sufferer`s lungs have to be in order for them to be catagorized as one who could never undergo any type of surgery which would require the use of general anesthia due to the serverity of the COPD? I do not believe that she is being truthful with us about her O2 Sats being at 80% because I am fairly certain that her physician would prescribe supplemental oxygen with with sats in this range. Am I correct regarding the use of supplemental O2 with 80% sats?
Thank you for answering my questions and giving your professional opinion regarding this situation.
Thanks for your interesting question. An oxygen saturation ("Sp02") of 80% is very low indeed and would be a sign of very severe lung disease. A person with an Sp02 of 80% would be unable to walk much or do normal household chores. The mucosal membranes (tongue, lips) and nail beds would be cyanosed (blue-tinged) and the legs might be swollen. Supplemental oxygen would be prescribed to relieve symptoms, increase effort tolerance and prevent progression of heart failure which results from chronic low oxygen levels.
There are no hard and fast rules about the severity of lung disease and prohibition of surgery. To make a reasonable decision we have to take into account the benefit of the surgery (life-saving vs improving the quality of life), the type of surgery (a procedure on a limb, or the spine, is less risky than abdominal or chest surgery), and the severity of the lung disease. Almost all patients can survive the surgical procedure itself, regardless of the severity of the lung disease. Problems generally occur during the recovery from surgery and anesthesia, because lung function invariably declines to some degree, and it may be impossible to "wean" the patient from mechanical ventilation.
This difficult situation is seen with open upper abdominal and chest surgery but is unlikely with other forms of surgical procedure. The odds of a good recovery can be improved by careful preparation before surgery - treating any infection, providing physical therapy, nutrition, and appropriate exercise, and bronchodilator therapy, as needed.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University