Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 9. Evaluation of the Patient with Pulmonary Disease Philip G. Boysen, MD, MBA

Key Points

"1. Ventilatory defects can be restrictive or obstructive in nature, with mixed defects often making diagnosis problematic.

2. Patients with chronic obstructive pulmonary disease usually do not show reduction in forced vital capacity (FVC) until late in the course of the disease.

3. The hallmark of chronic airflow obstruction is a decreased ratio of forced expiratory volume in 1 second (FEV₁) to FVC.

4. Flow–volume loops can differentiate among extrathoracic, intrathoracic, and fixed obstructions.

5. Asthma and chronic bronchitis lead to changes in the bronchial lumen wall such as hypertrophy and bronchospasm.

6. Emphysema is characterized by destruction of lung parenchyma and loss of surface area for gas transfer.

7. Chronic bronchitis is characterized by proliferative hypertrophy of bronchial glands and smooth muscle.

8. In asthma, the balance between (1) cyclic adenosine monophosphate–mediated bronchial relaxation and cyclic guanosine monophosphate–mediated bronchoconstriction and (2) sympathetic nervous system–mediated bronchial relaxation and parasympathetic nervous system bronchoconstriction is affected by antigens/IgE and mediators from mast cell contents (e.g., slow-releasing substance of anaphylaxis, eosinophilic chemotactic..."