From the Guidelines
A patient with well-controlled hypertension, glucose levels, and COPD is generally a suitable candidate for surgery and anesthesia, though they require careful preoperative evaluation, and the final decision to proceed with surgery and anesthesia should be made by the surgeon and anesthesiologist. The patient's chronic conditions are stable, but it is essential to optimize their pulmonary function before surgery by continuing bronchodilators, considering short-term steroids if indicated, and stopping smoking at least 8 weeks prior to elective procedures 1.
Preoperative Evaluation
The preoperative evaluation should include:
- Assessment of respiratory status using pulmonary function tests and arterial blood gases
- Review of medications, including antihypertensive medications, which should be continued through the perioperative period, with the possible exception of ACE inhibitors or ARBs, which might be held on the morning of surgery to prevent intraoperative hypotension 1
- Adjustment of insulin regimens for diabetic patients based on glucose monitoring
- Consideration of regional anesthesia techniques to reduce pulmonary complications
Management of Chronic Conditions
The management of chronic conditions, such as hypertension, diabetes, and COPD, is crucial to minimize perioperative risk.
- Hypertension should be controlled before surgery, but there is no clear consensus on a "safe" blood pressure for planned anesthesia and surgery 1
- Diabetes should be managed with adjusted insulin regimens and monitoring of glucose levels
- COPD should be managed with continued bronchodilators, consideration of short-term steroids, and optimization of pulmonary function
Final Decision
The final decision to proceed with surgery and anesthesia should be made by the surgeon and anesthesiologist, taking into account the patient's individual risk factors and medical history. Proper management of chronic conditions and careful preoperative evaluation can minimize perioperative risk and allow most patients to safely undergo necessary surgical procedures with appropriate monitoring and care 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pre-Op Clearance Statement
The patient's chronic conditions, including hypertension, glucose levels, and COPD, are stable. However, the final decision to proceed with surgery and anesthesia should be made by the surgeon and anesthesiologist, as they will be performing the procedures.
Key Considerations
- The patient's COPD is a significant consideration, as exacerbations can have a negative impact on disease progression, comorbidities, wellbeing, and mortality 2.
- The use of antidiabetic medications, such as metformin, may have a beneficial effect on COPD exacerbations, particularly in patients with diabetes mellitus 3, 4.
- However, the effectiveness of metformin in patients with COPD without diabetes mellitus is unclear, and its use in severe COPD exacerbations has not been shown to have a significant impact on blood glucose concentration or clinical outcomes 5.
Decision-Making
- The surgeon and anesthesiologist should carefully evaluate the patient's overall health and medical history to determine the risks and benefits of proceeding with surgery and anesthesia.
- They should consider the patient's COPD and its potential impact on the surgical procedure and post-operative recovery.
- The use of antidiabetic medications, such as metformin, should be carefully evaluated and considered as part of the patient's overall treatment plan.
Example of Pre-Op Clearance Statement
"The patient's chronic conditions, including hypertension, glucose levels, and COPD, are stable. However, the final decision to proceed with surgery and anesthesia should be made by the surgeon and anesthesiologist, as they will be performing the procedures and are best equipped to evaluate the patient's overall health and medical history."