II. Management: COPD - Perioperative Pulmonary Risk Reduction

  1. Assess Preoperative Pulmonary Risk Stratification
    1. Consider delaying or canceling surgery when pulmonary risk exceeds potential surgical benefit
  2. Optimize COPD Management
  3. Manage acute lung disease prior to surgery
  4. Optimize Nutritional Status
    1. Serum Albumin <3.5 g/dl is most predictive marker of pulmonary risk
  5. Consider Pulmonary RehabilitationConsultation
  6. Consider Stress Dose Steroids
  7. Tobacco Cessation
    1. Always recommend (but does not impact immediate surgery risk)

III. Management: Sleep Apnea

  1. Bring CPAP machine to hospital on day of surgery
  2. Close monitoring with anesthesia and sedation due to increased airway associated risks

IV. References

  1. Dummer (2009) Perioperative Guideline Review
  2. Qaseem (2006) Ann Intern Med 144(8):575-80 [PubMed]

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