Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

Abstract

The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words “analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive.” More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered.

Comparing laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease under spinal anesthesia and general anesthesia

“…Several meta-analyses and systematic reviews have reported an increasing worldwide prevalence of COPD that can be attributed to smoking, increased life expectancy, and less active lifestyles. For adults older than 40 years, COPD’s worldwide prevalence (as defined physiologically) is ~9–10% [ 2 , 3 ]. This high prevalence is putting a burden on both surgeons and anesthesiologists, who are both seeing an increase in the volume of high-risk respiratory patients.…”

“…During LC, insufflation with carbon dioxide (CO2) can cause pneumoperitoneum, in which the venous pressure is lower than the intra-abdominal pressure (IAP), preventing the resorption of CO2 and causing hypercapnia. Respiratory effects of pneumoperitoneum can be reduced lung volume, increased peak airflow pressure, and reduced pulmonary compliance [ 3 , 9 ].…”

Value of preoperative spirometry test in predicting postoperative pulmonary complications in high-risk patients after laparoscopic abdominal surgery

“…During laparoscopic surgery, lung volume and pulmonary compliance are reduced and peak airway pressure is increased. The diaphragm is displaced upward by increased intra-abdominal pressure, which results in a reduction in the functional residual capacity, with a ventilation–perfusion mismatch, and carbon dioxide absorption aggravates hypercapnia [23]. In addition, laparoscopic surgery is more advantageous for postoperative pulmonary function recovery than laparotomy; however, postoperative FVC and FEV1 are decreased even in laparoscopic surgery [24, 25].…”

Anaesthetic Management and Physiologic Effects of Pneumoperitoneum in Patients With Chronic Obstructive Pulmonary Disease Undergoing Laparoscopic Cholecystectomy

“…In particular, the creation of a pneumoperitoneum, an artificial space in the abdominal cavity inflated with CO 2 , is fundamental for laparoscopic surgeries. This process, however, can lead to hypercapnia (an excess of CO 2 in the bloodstream), increased intra-abdominal pressure (IAP), and decreased venous return, potentially precipitating cardiovascular instability [6,7].…”