"COPD is a fixed, expiratory airflow limitation — the lung empties slowly and incompletely. Every anaesthetic decision, from choosing regional over general to setting a long expiratory time, is aimed at the same enemy: dynamic hyperinflation and auto-PEEP."
How to use this topic — CritCare.in.Anaesthesia for the COPD Patient
A 63-year-old woman, chronic bidi smoker for 20 years, with a year of cough, wheeze and exertional dyspnoea (SpO₂ 91% on air, bilateral wheeze), posted for total laparoscopic hysterectomy — a "double hit" on respiratory mechanics (COPD + pneumoperitoneum + Trendelenburg). The principles apply to any COPD patient for any surgery.
- Regional wherever feasible; if GA, avoid airway irritation, use bronchodilating volatiles, and ventilate with low tidal volume + a long expiratory time to prevent dynamic hyperinflation / auto-PEEP; accept permissive hypercapnia; and remember that post-op care determines outcome as much as the intra-op plan.
Definition, Spectrum & Severity
GOLD definition, the emphysema / chronic bronchitis / small-airway spectrum, GOLD grades, risk factors and pack-years / smoking index.
🔬02 · INVESTIGATIONSInvestigations & PFTs
CXR & ECG findings, ABG, spirometry (FEV₁/FVC < 0.7) and the bedside pulmonary function tests & predictors of PPCs.
🚭03 · SMOKING & OPTIMISATIONSmoking & Pre-op Optimisation
Effects of smoking, the cessation timeline, vaping/ENDS, the optimisation checklist and LABA/LAMA drug therapy.
💉04 · ANAESTHETIC PLANRA vs GA & Drug Choices
Why regional is preferred, premedication, induction/maintenance agents, and the pneumoperitoneum + Trendelenburg problem.
🌬️05 · VENTILATIONVentilation & Auto-PEEP
Ventilatory mechanics, auto-PEEP / breath-stacking, lung-protective strategy, the external-PEEP 70% rule and bronchospasm.
🎓06 · PEARLSRecovery, PPCs & References
Deep vs awake extubation, post-op pulmonary complications, common mistakes, take-home messages and references.