To the Editor: The Clinical Crossroads article by Dr Smetana1 discussed a patient with severe symptomatic chronic obstructive pulmonary disease (COPD) associated with a past history of cardiopathy who was contemplating surgery for colon cancer. The patient was a long-term smoker with compromised pulmonary function and increased risk of PPCs.
For this patient, an accurate preoperative pulmonary evaluation is needed. History and physical examination together with spirometry, chest radiography, and venous blood testing are usually considered appropriate preoperative examinations for predicting risk of PPCs. While this may be true for routine preoperative screening2 even for patients with moderate COPD, for patients with severe and symptomatic COPD, arterial blood gas testing is also needed.3 Arterial blood gas measurement is recommended to rule out initial hypoxemia or hypercapnia.
Galetta D, Serra M, Occhionero L. COPD and Abdominal Surgery. JAMA. 2007;298(10):1158–1159. doi:10.1001/jama.298.10.1158-b
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