Chronic obstructive pulmonary disorder (COPD) is a condition that affects millions of adults in the United States. Because COPD affects your lung health and surgery stresses your lungs and body, it’s important to be aware of your potential risks if you need to have surgery.
If you have COPD and need surgery, there are lots of steps you can take to help you have a smooth surgery and recovery.
Keep reading more to learn about having anesthesia when you have COPD.
Anesthesia is an approach to providing medical interventions that help reduce a person’s pain during surgery, diagnostic testing, or other procedures.
Different approaches to anesthesia include:
- General anesthesia: A main form of anesthesia,general anesthesia involves administering medications that make you unconscious and unaware of the surgery that’s taking place.
- Regional anesthesia: Regional anesthesia involves injecting numbing medications into an area that will affect a larger area of the body. Examples are an epidural for childbirth or a nerve block for shoulder or knee surgery.
- Local anesthesia: Local anesthesia involves injecting numbing medications into a small area of the body, such as a tooth or in or around the eye for cataract removal surgery.
If you have COPD, regional and local anesthesia are a lower risk than general anesthesia and can often be used instead of general anesthesia for more minor procedures.
The anesthesia approach your surgical care team decides on will depend on the type of surgery you’re having. Your care team will explain to you the available options for your surgery type. However, some surgery types may only have one anesthesia option.
COPD is a group of lung disorders, including chronic bronchitis and emphysema, that affect the lung’s ability to empty well. The airways can also become inflamed. As a result, the lungs don’t work as effectively as they once did.
While the effects of COPD can vary based on how severe your condition is and what’s causing your COPD, people with COPD tend to have lungs that are less elastic and don’t empty as well.
The answer to whether you can have anesthesia if you have COPD depends on a number of factors. These include:
- Severity: If you have severe COPD, your risks when undergoing general anesthesia are much higher. If you have milder COPD, you’re less likely to experience complications.
- Anesthesia approach: Undergoing anesthesia doesn’t always mean you have a breathing tube for the procedure. Other techniques may affect your lungs less. Examples include spinal or epidural anesthesia or regional anesthesia. During these approaches, you breathe on your own without assistance from a ventilator.
- Surgical approach: Some surgeries require the use of a breathing tube for anesthesia. An example is coronary artery bypass grafting. Because there’s no other anesthesia approach option, your lungs have to be healthy enough to support the surgery.
- Surgery type: Some surgeries are emergency. Others are what’s called elective, meaning they’re not necessary to save your life but could improve your quality of life. When you have COPD, your surgeon and anesthesia providers will take into account whether your lungs can handle the surgery and whether it’s an emergency.
When you have COPD and need surgery, your surgeon’s goal is for you to have a good outcome. If your COPD is severe, your outcome isn’t just about whether the surgery goes well. Your outcome is also about how your lungs respond so you can recover and resume your daily activities.
The most serious risks for people with COPD after surgery include:
- postoperative respiratory failure
- prolonged mechanical ventilation
- developing other associated conditions
- death
If you have COPD, your risks of a poor outcome
Other elevated risks when you have COPD and are undergoing surgery include:
- cardiac arrest
- risks of early re-intubation
- myocardial infarction (heart attack)
- sepsis
- postoperative pneumonia
- renal insufficiency that requires dialysis
Having COPD and knowing you need surgery can also cause
Ventilator dependence occurs when you cannot breathe on your own after anesthesia and require continued ventilator support.
Some surgeries that require general anesthesia mean your breathing will be supported by a ventilator. A doctor called an anesthesiologist will insert an airway, such as an endotracheal tube, and use an anesthesia machine that has a ventilator to support your breathing.
When you have COPD, extubation — removing a breathing tube so you breathe on your own — can be more of a challenge after anesthesia. Your anesthesiologist and surgeon will evaluate your breathing to determine whether you can breathe on your own after surgery.
Ventilator dependence may cause an increased risk of longer hospital stays and the potential for increased treatment costs, according to 2022 research.
If you were to be extubated and require re-intubation, this may increase your risk of hospital-acquired pneumonia and death as well.
Unfortunately, it’s hard to predict who may become ventilator-dependent after surgery. That same 2022 research found that lower oxygen levels before surgery are the greatest indicator of ventilator dependence after surgery, not how severe your COPD is.
If you have moderate to severe COPD, your surgeon may recommend talking with a pulmonologist. This doctor specializes in lung conditions.
Your care team may recommend changes to your treatment regimen, such as adding bronchodilator medications or taking corticosteroids if you’re having a COPD exacerbation. This is a worsening of your COPD symptoms.
Your doctor may order testing known as pulmonary function testing (PFT). These noninvasive tests can measure how well your lungs are functioning. However, PFT is not always needed. Doctors may not order it for all people with COPD.
If you’ve recently experienced a COPD exacerbation or are in the midst of one, your surgeon may postpone surgery. After an exacerbation, your lungs need time to recover and heal.
Things you can do to prepare
While you can’t reverse all the effects COPD has on your lungs before surgery, there are a few steps you can take to improve how your lungs may respond.
An acronym for these steps is
- S = Smoking: Stop smoking if you smoke. Stopping smoking even 1 to 2 days before surgery can improve your outcomes. Stopping several weeks before is probably the best approach.
- P = Pulmonary disease: Doing breathing exercises to help train your breathing muscles may help reduce your risks of complications after surgery. A pulmonary rehabilitation specialist can give you examples of exercises to try.
- A = Anxiety: Reducing anxiety before surgery can help reduce heart palpitations and rapid breathing, which can all place greater demands on your heart and lungs.
- C= Cardiovascular disease: The heart and lungs are two organs whose functions depend on each other. If you have heart disease or heart problems, visiting your cardiologist before surgery to make sure your heart is strong enough for surgery is important.
- E = Exercise: Pulmonary rehabilitation and breathing exercises, such as using an incentive spirometer, can help you prepare for surgery. This device helps expand your lungs and keep you breathing effectively.
You can also ask your doctor about steps you can take based on your overall health and other health conditions you may have.
What is presurgery optimization?
When you need surgery, your surgeon or other healthcare professionals may talk about “optimization.” This term means you take every step possible to ensure you are in good health before your surgery.
If you have COPD, optimization steps may include quitting smoking and doing exercises to promote lung health.
It’s important to try and prevent postoperative lung infections after you’ve had surgery.
Walking as soon as you’re able after surgery and practicing your breathing exercises can also help you recover after anesthesia.
Having COPD can increase your risk of postoperative complications. One
A 2020 study with 419 people with COPD who underwent abdominal surgery found 28.8% of them experienced postoperative lung-related complications. Examples included:
- respiratory failure
- pleural effusion
- respiratory infections
Discussing your COPD with your surgeon before surgery is important. Your anesthesia care team will use approaches designed to protect your lungs. Examples include ventilation with low tidal volumes and carefully administering of intravenous fluids.
The following are some common questions about COPD and anesthesia.
Could I have COPD and not know it?
The American Lung Association estimates as many as 18 million U.S. adults have COPD and don’t know it.
Talk with your doctor if you have potential COPD symptoms, such as:
- a cough that won’t go away
- shortness of breath
- wheezing
- frequent respiratory infections
The sooner you treat possible COPD, the better your quality of life could be.
Does anesthesia cause COPD?
COPD is a progressive condition. It’s not usually the result of a one-time event, such as anesthesia.
The majority of people with COPD developed it from smoking. However, other causes include:
- air pollution exposure
- working with chemicals
- having a family history of alpha-1 antitrypsin deficiency
If I have regional anesthesia, do I have to be awake?
Regional anesthesia is often a safer alternative to general anesthesia when you have COPD.
However, it’s understandable you may not want to be “awake” while you are having surgery. In most cases, anesthesiologists will administer medications that will sedate you to relieve anxiety and pain but let you keep breathing on your own.
When you have COPD, you have a greater risk of postoperative complications. This doesn’t mean you will have complications, but you do have more risks than people who do not have COPD.
Working with your surgeon, anesthesia team, and any other doctors you may see before surgery is important to make sure your lungs are as healthy as possible.