EVAR and New COPD Diagnosis

84-year-old man with 5.9cm infra-renal AAA


  • Incidental finding on CT for urology
  • BPH – recent cystoscopy under GA with no issues


  • Undiagnosed COPD? Never seen respiratory physician, distant smoking history.
  • SpO2 = 84% on room air, decreased to 87% following walk up 2 FOS
  • Clinic spirometry: severe obstruction, FEV1/FVC = 0.59/1.78= 0.33
  • HARD card – previous difficult intubation, and history of suxamethonium apnoea
  • Hypertension = 183/92 in clinic



  • Referred to Rapid access respiratory clinic, appointment 4 weeks after planned surgery date
  • Consensus that we should await respiratory review if surgeon happy with delay
  • Needs formal spirometry – assessment of severity and bronchodilator reversibility
  • Potential to improve pre-operatively with COPD therapy
  • Download GOLD app at www.goldcopd.org for assessment and treatment algorithms

Conduct of anaesthesia

  • GA -history of difficult airway and significant anxiety
  • Most thought it would be prudent to secure the airway at the beginning of the case
  • Discussed with surgeon, anticipates 2-hour surgical time


  • Await respiratory review and formal spirometry