The perioperative management of patients with severe emphysema.

SEVERE EMPHYSEMA IS A frequent coexistent condition in surgical patients. It is a chronic obstructive pulmonary disease (COPD), part of a heterogenous group of diseases that also includes chronic bronchitis and asthma; COPD is characterized by airflow obstruction and hyperinflation.1 Specifically, emphysema is anatomically defined by “abnormal, permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by the destruction of their walls, and without obvious fibrosis.”2 More than 2.9 million people in the United States are affected by emphysema, and 13,000 people die each year.3,4 Patients are more likely to be older, male, and at the time of diagnosis have commonly lost 50% to 70% of their lung function.4-7 Optimal perioperative anesthetic care requires review of the anatomy and pathophysiology of emphysema, knowledge of the therapeutic options, understanding the reactions of emphysema patients to surgical and anesthetic procedures, and an awareness of common perioperative problems.