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Abstract
Patients with chronic obstructive pulmonary disease (COPD), have an increased chance of developing complications perioperatively. The causes of these problems are usually secondary to shallow breathing, poor lung expansion, basal lung collapse and subsequent infection.
In the general surgical population, thoracic wall and upper abdominal procedures are associated with the highest risk (10-40%) of pulmonary complications. (Brown et al., 1990)
After upper abdominal or thoracic wall surgery lung volumes are reduced in a restrictive pattern with severely reduced inspiratory capacity (IC) and vital capacity (VC) and a smaller, but important, reduction in functional residual capacity (FRC). A decrease in FRC contributes to atelectasis and ventilation-perfusion abnormalities resulting in hypoxemia. The reductions in VC and especially IC, limit the patients’ ability to cough effectively, leading to mucus retention, airways obstruction, atelectasis and an increased risk of infection. (Liu et al., 1995)
Because general anesthesia with tracheal intubation can elicit life-threatening bronchospasm in patients with bronchial hyperactivity; epidural anesthesia is often preferred. Thoracic epidural anesthesia (TEA) improves pulmonary dynamics after thoracic wall and upper abdominal surgery.
This occurs due to its indirect effect on the vital capacity through the analgesia produced, which permits better spontaneous ventilation
Despite sympathetic blockade, thoracic epidural anesthesia (TEA) does not increase airway obstruction and evokes only a mild respiratory motor blockade. (Groeben et al., 2002)
The study included 60 ASA (American Society of Anesthesiologists) II or III COPD patients, electively scheduled for upper abdominal or thoracic wall surgery.
They were divided into 2 equal groups:
Group I:
30 patients received standardized general anesthesia with endotracheal intubation and mechanical ventilation.