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Criteria for Evaluating Patients with COPD Prior to General Anesthesia

Purpose: To evaluate a patient with COPD prior to anesthesia and surgery using the criteria of Milledge and Nunn.

Description

Milledge and Nunn evaluated patients with chronic obstructive pulmonary disease (COPD) prior to general anesthesia and surgery. They used arterial blood gases to help identify patients who require prolonged post-operative ventilatory support. The authors are from Northwick Park Hospital in Middlesex, England.


 

Patient selection:

(1) chronic obstructive lung disease, all with dyspnea on exertion

(2) preoperative FEV1 <= 1 liter ( <= 50% of predicted for age and gender)

 

Preoperative management included control of secretions with preoperative physiotherapy and antibiotics to control exacerbations of chronic bronchitis.

 

Regional anesthesia is preferred since it reduces the need for post-operative opioids that might reduce the respiratory sensitivity to hypercarbia.

PaO2 on Room Air

PaCO2

Post-Operative Course

> 7.3 kPa (> 55 mm Hg)

<= 5.9 kPa (<= 45 mm Hg)

routine

<= 7.3 kPa (<= 55 mm Hg)

<= 5.9 kPa (<= 45 mm Hg)

routine or prolonged use of supplemental oxygen

<= 7.3 kPa (<= 55 mm Hg)

6.0 - 6.6 kPa (45.1 - 49.6 mm Hg)

routine or prolonged use of supplemental oxygen

<= 7.3 kPa (<= 55 mm Hg)

> 6.6 kPa (>= 49.7 mm Hg

full ventilatory support required

 


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Specialty

Objective

ICD-10