A 66-year-old man is being admitted in the surgical pre-assessment clinic for an elective abdominoperineal resection for rectal carcinoma. Case He has chronic obstructive pulmonary disease (COPD), however, he does not require home oxygen at present \ He is a heavy smoker (15 cigarettes a day). Has mild hypertension, and there is no evidence of cardiac disease. He uses inhalers daily and consumes oral theophylline and amlodipine. His exercise tolerance is 30 yards and has had two previous admissions to hospital with breathing problems. He has never required admission to an intensive care unit.
His father died of lung cancer. Physical Examination His blood pressure is 146/92 mmHg, pulse rate 88/min and oxygen saturations are 93% on air. The heart sounds are normal. On auscultation of the chest, there is moderate air entry with some scattered wheeze. The rest of the examination is…
