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Lung disease and smoking before surgery
Preparation aims to bring the patient with asthma or COPD to surgery in their best state, to stop smoking, and under anaesthesia to avoid airway stimulation at a light plane and to allow a long expiration.
Why it matters in the exam
The exam asks when to postpone surgery in an asthmatic, how to anaesthetise a patient with reactive airways (propofol or ketamine, sevoflurane, avoiding intubation at a light plane), what to do for bronchospasm during surgery, how to ventilate a COPD patient (long expiratory time, beware of auto-PEEP), and the effect of stopping smoking at different times before surgery.
Stopping smoking even for 12–24 hours lowers blood CO and improves oxygen carriage; stopping for at least 4 weeks reduces wound complications, and at least 8 weeks reduces lung complications. In asthma all inhalers are continued on the day of surgery, and with poorly controlled asthma elective surgery is postponed and the asthma optimised, sometimes with a short course of steroids. Routine lung function tests are not needed before surgery other than lung resection.
Postoperative lung complications — atelectasis, pneumonia, respiratory failure — are linked to age, lung disease, a recent respiratory infection, anaemia, an upper abdominal or thoracic incision, long surgery and emergency surgery. To reduce them regional anaesthesia is used where possible, with good analgesia that allows deep breathing and coughing, breathing exercises, early mobilisation and confirmation that no residual paralysis remains. In a COPD patient who retains CO2, the postoperative saturation target is 88%–92%.
Key points
- Asthma: continue inhalers; poorly controlled — postpone.
- Anaesthesia: propofol or ketamine, sevoflurane, no stimulation at a light plane.
- Bronchospasm: deepen, salbutamol, adrenaline; exclude a mechanical cause and anaphylaxis.
- COPD: long expiration; saturation 88%–92% in CO2 retainers.
- Smoking: 8 weeks to reduce lung complications; even a day helps.
Summary table
| Situation | What is done | Exam point |
|---|---|---|
| Asthma before surgery | Continue inhalers; poorly controlled asthma — postpone and optimise | Do not intubate at a light plane |
| Bronchospasm during surgery | Deepen anaesthesia with a volatile agent, 100% oxygen, salbutamol through the tube, adrenaline if severe | Exclude a kinked tube, an endobronchial tube and anaphylaxis |
| COPD on the ventilator | Long expiration, low rate; beware of auto-PEEP | With bullae — no N2O |
| Smoking | 12–24 hours: less CO; 4 weeks: fewer wound complications; 8 weeks: fewer lung complications | Every stop helps |
| After surgery | Analgesia, breathing exercises, mobilisation; COPD CO2 retainer — saturation 88%–92% | Full reversal of paralysis |
In the full version for subscribers
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Sources
- GINA Global Strategy for Asthma Management and Prevention, 2024 — Surgery and asthma
- GOLD Global Strategy for COPD, 2024 — COPD and surgery
- Miller's Anesthesia, 9th edition (2020) — Anesthetic Implications of Concurrent Diseases: Pulmonary Disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.