Perioperative Medication Management for COPD Patient Undergoing Hip Fracture Surgery
Continue all COPD maintenance medications (livolin/bronchodilator, formonide/corticosteroid, nebzmart) through the morning of surgery, and resume them as soon as possible postoperatively. 1
Medications to Continue
COPD Maintenance Therapy - MUST CONTINUE
Long-acting bronchodilators (LABA/LAMA) and inhaled corticosteroids should be continued perioperatively to prevent acute exacerbations and postoperative pulmonary complications 1, 2
Formonide (formoterol + corticosteroid combination) should be continued through surgery, as withdrawal increases risk of COPD exacerbation and postoperative respiratory failure 2, 3
Livolin (bronchodilator) should be continued, as bronchodilators reduce postoperative pulmonary complications in COPD patients 4, 2
Nebzmart (if this is a nebulized bronchodilator) should be continued, though may need to switch to metered-dose inhaler or continue nebulization postoperatively 1
Studies show that introducing or continuing COPD treatment perioperatively reduces postoperative pulmonary complications by 91% (OR 0.09,95% CI 0.01-0.81) 2
Pain Management
G siladol (analgesic) can be continued but coordinate with anesthesia team regarding timing of last dose before surgery 5
Ensure adequate postoperative pain control is planned, as uncontrolled pain impairs respiratory mechanics in COPD patients 4
Urinary Medications
- Urispas (flavoxate - urinary antispasmodic) can be continued perioperatively as it does not significantly impact surgical risk 5
Critical Perioperative Considerations
High-Risk Population
COPD patients have 7.6-fold increased 30-day mortality after surgery (6.1% vs 0.8% in controls, P=0.03) 4
Postoperative respiratory failure occurs in 10.4% of COPD patients versus 2.5% in non-COPD patients (P=0.02) 4
Upper abdominal or thoracic surgery carries highest risk, but orthopedic surgery still poses significant pulmonary risk 2
Medication Timing on Surgery Day
Administer morning doses of all COPD medications on the day of surgery, ideally 2-4 hours before anesthesia 1, 5
Do NOT withhold bronchodilators or inhaled corticosteroids - withdrawal potential and disease progression risk outweigh any theoretical anesthetic interactions 5
Coordinate with anesthesia regarding G siladol timing to avoid drug interactions 5
Postoperative Management
Resume all COPD medications immediately when patient can take oral/inhaled medications, ideally within 4-6 hours postoperatively 1, 3
Use nebulized bronchodilators initially if patient cannot use inhalers effectively due to pain or positioning restrictions 1
Monitor for exacerbations closely - COPD patients have longer ICU stays (P=0.02) and hospital stays (P=0.04) after surgery 4
Common Pitfalls to Avoid
Never discontinue inhaled corticosteroids perioperatively - this dramatically increases exacerbation risk and postoperative complications 1, 2, 3
Do not substitute short-acting for long-acting bronchodilators perioperatively - maintain the patient's established regimen 1
Avoid oxygen-driven nebulizers if patient develops hypercapnia postoperatively - use compressed air with supplemental oxygen via nasal cannula 1, 6
Monitor arterial blood gases if patient shows signs of respiratory distress, as bronchodilators can affect CO2 levels 6