Kenapa spinal anastesia merupakan kontrainndikasi pada pasien dengan copd?

forced expiration.
Patients with severe chronic lung disease may
rely upon accessory muscles of respiration (inter
costal and abdominal muscles) to actively inspire
or exhale. High levels of neural blockade will impair
these muscles. Similarly, eff ective coughing and
clearing of secretions require these muscles for expi
ration. For these reasons, neuraxial blocks should
be used with caution in patients with limited respi
ratory reserve. Th ese deleterious eff ects need to be
weighed against the advantages of avoiding airway
instrumentation and positive-pressure ventilation.
For surgical procedures above the umbilicus, a pure
regional technique may not be the best choice in
patients with severe lung disease. On the other hand,
these patients may benefi t from the eff ects of tho
racic epidural analgesia (with dilute local anesthetics
and opioids) in the postoperative period, particu
larly following upper abdominal or thoracic surgery.
Some evidence suggests that postoperative thoracic
epidural analgesia in high-risk patients can improve
pulmonary outcome by decreasing the incidence of
pneumonia and respiratory failure, improving oxy
genation, and decreasing the duration of mechanical
ventilatory support.