Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Anesthesia for patients with chronic obstructive pulmonary disease

Rachel Budithi, MD
Sylvia Y Dolinski, MD, FCCP
Section Editor
Peter D Slinger, MD, FRCPC
Deputy Editors
Nancy A Nussmeier, MD, FAHA
Helen Hollingsworth, MD


Chronic obstructive pulmonary disease (COPD) and its subtypes (emphysema, chronic bronchitis, and chronic obstructive asthma) are important risk factors for postoperative pulmonary complications (eg, pneumonia, reintubation after initial extubation, and prolonged intubation >48 hours), as well as for increased length of hospital stay and mortality.

This topic will discuss anesthetic management of COPD patients undergoing noncardiac surgery. Anesthetic management of patients with asthma, evaluation of preoperative pulmonary risk, perioperative strategies to reduce pulmonary complications, and postoperative management are discussed in detail elsewhere.

(See "Anesthesia for adult patients with asthma".)

(See "Evaluation of preoperative pulmonary risk".)

(See "Strategies to reduce postoperative pulmonary complications in adults".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 10, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Fields AC, Divino CM. Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients. Surgery 2016; 159:1210.
  2. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 2006; 144:575.
  3. Smetana GW, Lawrence VA, Cornell JE, American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144:581.
  4. Milledge JS, Nunn JF. Criteria of fitness for anaesthesia in patients with chronic obstructive lung disease. Br Med J 1975; 3:670.
  5. Silvanus MT, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology 2004; 100:1052.
  6. Walters JA, Tan DJ, White CJ, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; :CD001288.
  7. Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23:932.
  8. Guan Z, Lv Y, Liu J, et al. Smoking Cessation Can Reduce the Incidence of Postoperative Hypoxemia After On-Pump Coronary Artery Bypass Grafting Surgery. J Cardiothorac Vasc Anesth 2016; 30:1545.
  9. Valkenet K, van de Port IG, Dronkers JJ, et al. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 2011; 25:99.
  10. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:871.
  11. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2:8.
  12. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215.
  13. Licker M, Schweizer A, Ellenberger C, et al. Perioperative medical management of patients with COPD. Int J Chron Obstruct Pulmon Dis 2007; 2:493.
  14. Hong CM, Galvagno SM Jr. Patients with chronic pulmonary disease. Med Clin North Am 2013; 97:1095.
  15. Tverskoy M, Fleyshman G, Ezry J, et al. Midazolam-morphine sedative interaction in patients. Anesth Analg 1989; 68:282.
  16. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187:347.
  17. Yamakage M, Iwasaki S, Namiki A. Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. J Anesth 2008; 22:412.
  18. Dupont J, Tavernier B, Ghosez Y, et al. Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane. Br J Anaesth 1999; 82:355.
  19. Ferguson MK. Pulmonary Physiologic Assessment of Operative Risk. In: General Thoracic Surgery, 7th, Shields TW, LoCiero J, Reed CE, Feins RH (Eds), Lippincott, Williams & Wilkins, 2009. p.325.
  20. Joris J, Kaba A, Lamy M. Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures. Br J Anaesth 1997; 79:422.
  21. Rehder K. Postural changes in respiratory function. Acta Anaesthesiol Scand Suppl 1998; 113:13.
  22. Tanskanen P, Kyttä J, Randell T. The effect of patient positioning on dynamic lung compliance. Acta Anaesthesiol Scand 1997; 41:602.
  23. Gunnarsson L, Tokics L, Lundquist H, et al. Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment. Eur Respir J 1991; 4:1106.
  24. Pelosi P, Croci M, Calappi E, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995; 80:955.
  25. El-Shafie M, Ashraf M, Mahfouz M. Prone position in artificially ventilated chronic obstructive pulmonary disease patients assessment of lung mechani. Med J Cairo Univ 2010; 78:33.
  26. Mure M, Domino KB, Lindahl SG, et al. Regional ventilation-perfusion distribution is more uniform in the prone position. J Appl Physiol (1985) 2000; 88:1076.
  27. Galizia G, Prizio G, Lieto E, et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc 2001; 15:477.
  28. Hsieh CH. Laparoscopic cholecystectomy for patients with chronic obstructive pulmonary disease. J Laparoendosc Adv Surg Tech A 2003; 13:5.
  29. Fahy BG, Barnas GM, Nagle SE, et al. Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible. Anesth Analg 1996; 82:501.
  30. Gramatica L Jr, Brasesco OE, Mercado Luna A, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 2002; 16:472.
  31. Hausman MS Jr, Jewell ES, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg 2015; 120:1405.
  32. van Lier F, van der Geest PJ, Hoeks SE, et al. Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology 2011; 115:315.
  33. Westhorpe RN, Ludbrook GL, Helps SC. Crisis management during anaesthesia: bronchospasm. Qual Saf Health Care 2005; 14:e7.
  34. Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care 2012; 16:323.
  35. Bailey PL, Pace NL, Ashburn MA, et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73:826.
  36. Xu CX, Chen X, Jia Y, et al. Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy. World J Gastroenterol 2013; 19:4791.
  37. Stolz D, Grendelmeier P, Jahn K, Tamm M. Propofol sedation for flexible bronchoscopy in patients with and without chronic obstructive pulmonary disease. Eur Respir J 2013; 42:Suppl 57 P3772.
  38. Nishimori M, Low JH, Zheng H, Ballantyne JC. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 2012; :CD005059.
  39. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; :CD004088.
  40. Groeben H. Epidural anesthesia and pulmonary function. J Anesth 2006; 20:290.
  41. Panaretou V, Toufektzian L, Siafaka I, et al. Postoperative pulmonary function after open abdominal aortic aneurysm repair in patients with chronic obstructive pulmonary disease: epidural versus intravenous analgesia. Ann Vasc Surg 2012; 26:149.
  42. Groeben H, Schäfer B, Pavlakovic G, et al. Lung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery. Anesthesiology 2002; 96:536.
  43. Guay J, Choi P, Suresh S, et al. Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2014; :CD010108.
  44. Barbosa FT, Jucá MJ, Castro AA, Cavalcante JC. Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database Syst Rev 2013; :CD007083.
  45. Pöpping DM, Elia N, Van Aken HK, et al. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Ann Surg 2014; 259:1056.
  46. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321:1493.
  47. Sanchez M, Malhotra N, Lin L. End-stage pulmonary disease and brachial plexus regional anesthesia: their implications on perioperative pulmonary function. Semin Cardiothorac Vasc Anesth 2012; 16:59.
  48. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg 1992; 74:352.
  49. Gentili ME, Lefoulon-Gourves M, Mamelle JC, Bonnet F. Acute respiratory failure following interscalene block: complications of combined general and regional anesthesia. Reg Anesth 1994; 19:292.
  50. Kim ES, Bishop MJ. Endotracheal intubation, but not laryngeal mask airway insertion, produces reversible bronchoconstriction. Anesthesiology 1999; 90:391.
  51. Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997; 78:356.
  53. Eames WO, Rooke GA, Wu RS, Bishop MJ. Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation. Anesthesiology 1996; 84:1307.
  54. Wu RS, Wu KC, Sum DC, Bishop MJ. Comparative effects of thiopentone and propofol on respiratory resistance after tracheal intubation. Br J Anaesth 1996; 77:735.
  55. Pedersen CM, Thirstrup S, Nielsen-Kudsk JE. Smooth muscle relaxant effects of propofol and ketamine in isolated guinea-pig trachea. Eur J Pharmacol 1993; 238:75.
  56. Pizov R, Brown RH, Weiss YS, et al. Wheezing during induction of general anesthesia in patients with and without asthma. A randomized, blinded trial. Anesthesiology 1995; 82:1111.
  57. Adamzik M, Groeben H, Farahani R, et al. Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma. Anesth Analg 2007; 104:168.
  58. Chang HY, Togias A, Brown RH. The effects of systemic lidocaine on airway tone and pulmonary function in asthmatic subjects. Anesth Analg 2007; 104:1109.
  59. Yukioka H, Hayashi M, Terai T, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients. Anesth Analg 1993; 77:309.
  60. Chung KS, Sinatra RS, Halevy JD, et al. A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction. Can J Anaesth 1992; 39:774.
  61. Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36:1022.
  62. Rooke GA, Choi JH, Bishop MJ. The effect of isoflurane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology 1997; 86:1294.
  63. Dikmen Y, Eminoglu E, Salihoglu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 2003; 58:745.
  64. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014; 118:85.
  65. Forget P, Pirson E, Scholtès JL. Anaphylactic bronchospasm due to propofol. Anaesth Intensive Care 2009; 37:865.
  66. Bruder EA, Ball IM, Ridi S, et al. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev 2015; 1:CD010225.
  67. Laxenaire MC, Mertes PM, Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 2001; 87:549.
  68. Laake JH, Røttingen JA. Rocuronium and anaphylaxis--a statistical challenge. Acta Anaesthesiol Scand 2001; 45:1196.
  69. Sadleir PH, Clarke RC, Bunning DL, Platt PR. Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth 2013; 110:981.
  70. Reddy JI, Cooke PJ, van Schalkwyk JM, et al. Anaphylaxis is more common with rocuronium and succinylcholine than with atracurium. Anesthesiology 2015; 122:39.
  71. Crilly H, Rose M. Anaphylaxis and anaesthesia - can treating a cough kill? Aust Prescr 2014; 37:74.
  72. Goff MJ, Arain SR, Ficke DJ, et al. Absence of bronchodilation during desflurane anesthesia: a comparison to sevoflurane and thiopental. Anesthesiology 2000; 93:404.
  73. White PF, Tang J, Wender RH, et al. Desflurane versus sevoflurane for maintenance of outpatient anesthesia: the effect on early versus late recovery and perioperative coughing. Anesth Analg 2009; 109:387.
  74. Flacke JW, Flacke WE, Bloor BC, et al. Histamine release by four narcotics: a double-blind study in humans. Anesth Analg 1987; 66:723.
  75. Rosow CE, Moss J, Philbin DM, Savarese JJ. Histamine release during morphine and fentanyl anesthesia. Anesthesiology 1982; 56:93.
  76. Prieto-Lastra L, Iglesias-Cadarso A, Reaño-Martos MM, et al. Pharmacological stimuli in asthma/urticaria. Allergol Immunopathol (Madr) 2006; 34:224.
  77. Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012; 308:1651.
  78. Gu WJ, Wang F, Liu JC. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials. CMAJ 2015; 187:E101.
  79. Gammon RB, Shin MS, Buchalter SE. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 1992; 102:568.
  80. Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O. What tidal volumes should be used in patients without acute lung injury? Anesthesiology 2007; 106:1226.
  81. Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010; 111:120.
  82. Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg 2010; 111:129.
  83. Grosse-Sundrup M, Henneman JP, Sandberg WS, et al. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012; 345:e6329.
  84. Thilen SR, Hansen BE, Ramaiah R, et al. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology 2012; 117:964.
  85. Lumb A, Biercamp C. Chronic obstructive pulmonary disease and anaesthesia. Contin Educ Anaesth Crit Care Pain 2014; 14:1.
  86. Glossop AJ, Shephard N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth 2012; 109:305.
  87. Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med 2011; 37:918.
  88. Faria DA, da Silva EM, Atallah ÁN, Vital FM. Noninvasive positive pressure ventilation for acute respiratory failure following upper abdominal surgery. Cochrane Database Syst Rev 2015; :CD009134.
Topic Outline