Anesthetic techniques used in the management of patients with significant pulmonary disease include:

a. Intubation at a deep level of anesthesia

b. Choice of an anesthetic agent which produces bronchodilatation

c. The use of epidural analgesia for postoperative pain control

Patients with significant pulmonary diseases require special anesthetic techniques. Obstructive pulmonary disease can either be chronic (COPD) or acute (asthma). In either case, the reversible component of obstruction should be reversed prior to elective surgery. In patients with reactive airway disease, the endotracheal tube may induce severe bronchospasm. Even in patients who are well treated preoperatively, reactive bronchospasm may complicate anesthetic induction and emergence from anesthesia. The principal method used to prevent or diminish this “foreign body” induced bronchospasm is intubation of the patient at a deep level of anesthesia when reflexes are blunted. The classic way of managing a patient with severe asthma is to induce with an agent that produces bronchodilatation and to ventilate the patient with an inhalation agent until deeply anesthetized prior to laryngoscopy and intubation. The patient should be extubated while spontaneously ventilating, but with the inhalation agent still in effect, bringing the patient to consciousness while ventilating by mask. Because of the potential adverse effects of systemic narcotics on respiratory drive, the use of epidural narcotics and local anesthetics for postoperative pain control has become very popular. These techniques allow the patient to be extubated earlier, and patients with intrathoracic and upper abdominal surgery, help restore pulmonary function toward preoperative values. Preoperative use of intermittent positive pressure breathing has not been demonstrated to decrease the incidence of postoperative pulmonary complications.