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Anaesthesia and postoperative analgesia in older patients with chronic obstructive pulmonary disease : special considerations.

机译：老年慢性阻塞性肺疾病患者的麻醉和术后镇痛：特殊考虑。

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Chronic obstructive pulmonary disease (COPD) and older age are known to be independent risk factors for severe perioperative adverse outcomes after surgery. A basic understanding of the disease, careful preoperative evaluation and preparation of the patient, as well as a tailored anaesthetic management plan might help to decrease complications in this patient population.Aging affects the pharmacokinetics and pharmacodynamics of almost all drugs and therefore the dosage must be adapted in older patients. The type of anaesthesia (general versus regional anaesthesia) has no substantial effect on perioperative morbidity and mortality. Most patients, even with severe COPD, tolerate general anaesthesia without major problems. One important goal of the anaesthetic management is to prevent reflex-induced bronchoconstriction, which can be accomplished by the use of volatile anaesthetics. Early recovery can be facilitated by the use of short-acting drugs, such as propofol and the new opioid remifentanil. Judicious use of neuromuscular blocking agents is necessary because of the risk of residual paralysis, and those agents associated with histamine liberation should be avoided. Ventilation requires long expiration times to avoid air trapping, and hyperinflation to avoid the possible threat of pneumothorax and a decrease in cardiac output.For postoperative analgesia, a balanced regimen consisting of regional analgesia with local anaesthetics and NSAIDs should be preferred. This will enhance analgesia and reduce opioid toxicity, which is important in patients with COPD, where respiratory depression is especially dangerous.
机译：慢性阻塞性肺疾病（COPD）和年龄较大是导致术后严重围手术期不良后果的独立危险因素。对疾病的基本了解，认真的术前评估和患者准备以及定制的麻醉管理计划可能有助于减少该患者群体的并发症。衰老会影响几乎所有药物的药代动力学和药效学，因此剂量必须适用于老年患者。麻醉类型（全身麻醉与区域麻醉）对围手术期的发病率和死亡率没有实质性影响。大多数患者，即使患有严重的COPD，也可以耐受全身麻醉，而没有重大问题。麻醉管理的一个重要目标是防止反射性支气管收缩，这可以通过使用挥发性麻醉剂来实现。使用短效药物（如异丙酚和新的阿片类药物瑞芬太尼）可以促进早期康复。由于存在残留麻痹的危险，必须明智地使用神经肌肉阻滞剂，应避免与组胺释放有关的那些药物。通气需要较长的呼气时间以避免空气滞留，而通气则需要避免通气过度并避免可能的气胸威胁和心输出量减少。对于术后镇痛，应首选由局部镇痛，局部麻醉和NSAID组成的平衡方案。这将增强镇痛效果并降低阿片类药物的毒性，这在COPD患者（呼吸抑制尤其危险）中非常重要。

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