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

Authors
Park, SukheeOh, Eun JungHan, SangbinShin, BeomsuShin, Sun HyeIm, YunjooSon, Yong HoonPark, Hye Yun
Issue Date
Jan-2020
Publisher
MDPI
Keywords
airflow obstruction; chronic obstructive pulmonary disease; neuromuscular blocking reversal agent; postoperative pulmonary complications; protective lung ventilation
Citation
JOURNAL OF CLINICAL MEDICINE, v.9, no.1
Journal Title
JOURNAL OF CLINICAL MEDICINE
Volume
9
Number
1
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74295
DOI
10.3390/jcm9010150
ISSN
2077-0383
Abstract
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.
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Oh, Eun Jung
의과대학 (의학부(임상-광명))
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