The impact of general anesthesia on postoperative respiratory complications in patients with chronic obstructive pulmonary disease (COPD): A literature review

Moultrie, GA

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease characterized by airway narrowing and alveoli breakdown that eventually causes air trapping leading to increased Total Lung Capacity (TLC) and compromised expiration. COPD includes chronic bronchitis and emphysema, which are common among smokers. Patients with COPD are at increased risk of perioperative complications, including but not limited to: Increased post-operative pulmonary complications (PPCs), increased risk of respiratory infections, respiratory failure, prolonged ventilator dependence, and subsequent increased length of hospital stay. Understanding the relationship between COPD severity and postoperative outcomes is critical for optimizing perioperative management and reducing morbidity and mortality in this patient population. This literature review evaluates the effects and perioperative risks associated with general anesthesia in COPD patients. Specifically, it examines the impact of COPD severity on postoperative outcomes and identifies key risk factors contributing to PPCs.

Thorough research was conducted through the PCOM online library to identify relevant peer-reviewed articles examining the relationship between COPD and general anesthesia. Studies were selected based on their relevance to perioperative risks, postoperative respiratory failure, and anesthetic considerations in COPD patients.

Preliminary evidence suggests that while COPD severity, as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is not directly correlated with postoperative respiratory failure, lower preoperative arterial oxygen pressure (PaO₂) is a significant predictor of respiratory complications (Hou et al., 2022).

Additionally, the study “Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study” showed that prolonged ventilation, higher ASA classification, and COPD and smoking history are important risk factors for PPCs. (Feng et al., 2024).

These findings highlight the importance of individualized perioperative strategies for COPD patients undergoing general anesthesia. Enhancing preoperative oxygenation, minimizing ventilatory pressures, and tailoring anesthetic techniques can reduce the incidence of PPCs. Future research should focus on refining perioperative management protocols to improve the post-operative course in COPD patients.