Anaesthesia for lung volume reduction surgery

Journal Article


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Journal Title

South African Journal of Anaesthesia and Analgesia

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MedPharm Publications


University of Cape Town

Chronic obstructive pulmonary disease (COPD) is a common condition with high morbidity and mortality rates.1 The condition, which is primarily a complication of smoking, is a chronic, slowly progressive disorder characterised by airway obstruction.2 The definition includes chronic bronchitis and emphysema with permanent destructive enlargement of distal pulmonary airspaces. Consequently, there is loss of normal lung architecture resulting in loss of elastic recoil of lung tissue leading to collapse of small airways, expiratory airflow limitation, air trapping, hyperinflation of the lungs and progressive enlargement of the thoracic cage. Expansion of the thorax leads to flattening of the diaphragm, in-drawing of the lower ribs and compromised chest wall mechanics. The ribs are lifted and flattened leading to increased total lung capacity and residual volume, with reduced FEV1 and increased work of breathing. As the disease progresses, patients must breathe at a higher lung volume to achieve the flows necessary to meet ventilatory requirements. At end-stage disease, the patient is dyspnoeic and has a severely restricted exercise capacity.3 Once the patient has reached a stage where the FEV1 < 0.75 L, the 1-year mortality is in the region of 30%4 and the patient will require frequent hospital admission for treatment of exacerbations of the condition.