Severe COPD Anaesthetic Choice — FRCA Final MCQ

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ModeratePreoperative AssessmentSevere COPD Anaesthetic ChoiceFRCA Final

A 65-year-old man with stable, optimised severe chronic obstructive pulmonary disease has an FEV1 of 30% predicted. He is too breathless to leave his home and becomes breathless while dressing (MRC dyspnoea grade 5). He requires elective open unilateral inguinal hernia repair and can lie supine and cooperate during awake surgery. Which anaesthetic technique is most appropriate to minimise postoperative respiratory complications?

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Correct answer: C — Local field-block anaesthesia alone

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

D is most appropriate. For a cooperative patient undergoing open unilateral repair, local surgical infiltration and field block can provide operative anaesthesia while avoiding airway instrumentation, positive-pressure ventilation, systemic anaesthetic exposure and neuraxial sympathetic or motor block. In patients with COPD, avoiding general anaesthesia is associated with less pneumonia, prolonged ventilation and unplanned intubation. Both A and B remain general anaesthesia; a supraglottic airway may reduce airway stimulation but does not remove ventilatory or systemic drug effects. Spinal anaesthesia also avoids airway instrumentation but is more extensive than necessary and adds risks including hypotension, urinary retention and respiratory compromise from an unexpectedly high block or accompanying sedation. Thoracic epidural anaesthesia is disproportionate for unilateral groin surgery and a high block may impair intercostal muscle function. Sedation should not be routine; if subsequently required, it should be minimal, carefully titrated and fully monitored.

Reference: NIHR Global Health Research Group. Global anaesthesia practice using inguinal hernia surgery as a tracer condition, Anaesthesia, 2025. https://pubmed.ncbi.nlm.nih.gov/40923367/; supported by Hausman MS et al. Regional versus general anesthesia in surgical patients with COPD, Anesthesia & Analgesia, 2015. https://pubmed.ncbi.nlm.nih.gov/25526396/