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Open AccessArticle

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

1
Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon 22711, Korea
2
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
3
Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon 24341, Korea
4
Department of Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
5
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
*
Authors to whom correspondence should be addressed.
Park S. and Oh E.J. contributed equally as joint first authors.
J. Clin. Med. 2020, 9(1), 150; https://doi.org/10.3390/jcm9010150
Received: 24 December 2019 / Revised: 31 December 2019 / Accepted: 3 January 2020 / Published: 6 January 2020
(This article belongs to the Special Issue Anesthesia for the High-Risk Patient)
Patients with chronic obstructive pulmonary disease (COPD) exhibit airflow limitation and suboptimal lung function, and they are at high risk of developing postoperative pulmonary complications (PPCs). We aimed to determine the factors that would decrease PPC risk in patients with COPD. We retrospectively analyzed 419 patients with COPD who were registered in our institutional PPC database and had undergone an abdominal surgery under general anesthesia. PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm; the presence or type of PPC was diagnosed by respiratory physicians and recorded in the database before this study. Binary logistic regression was used for statistical analysis. Of the 419 patients, 121 patients (28.8%) experienced 200 PPCs. Multivariable analysis showed three modifiable anesthetic factors that could decrease PPC risk: low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced neuromuscular blockade reversal. We found that the 90-day mortality risk was significantly greater in patients with PPC than in those without PPC (5.8% vs. 1.3%; p = 0.016). Therefore, PPC risk in patients with COPD can be decreased if low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced reversal during abdominal surgery are efficiently managed, as these factors result in decreased postoperative mortality. View Full-Text
Keywords: airflow obstruction; chronic obstructive pulmonary disease; neuromuscular blocking reversal agent; postoperative pulmonary complications; protective lung ventilation airflow obstruction; chronic obstructive pulmonary disease; neuromuscular blocking reversal agent; postoperative pulmonary complications; protective lung ventilation
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Park, S.; Oh, E.J.; Han, S.; Shin, B.; Shin, S.H.; Im, Y.; Son, Y.H.; Park, H.Y. Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery. J. Clin. Med. 2020, 9, 150.

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