Having surgery when you have a cough or cold can be concerning. As a respiratory illness, a cough or cold affects the lungs and airways which need to be in good health before undergoing anesthesia for surgery. Additionally, coughing can make recovery from surgery more difficult. However, minor coughs and colds do not automatically mean surgery needs to be postponed. Here is a quick overview of the factors surgeons consider when deciding if surgery can proceed with a cough:
- Severity of the cough – Mild, intermittent coughs are less concerning than severe, unremitting coughs.
- Cause of the cough – Coughs from minor viral illnesses are viewed differently than chronic coughs from conditions like COPD.
- Type of surgery – Surgeries with more risk and recovery considerations may be postponed more readily.
- Timing of the cough – Coughs lasting weeks require different approaches than new coughs.
- Ability to control cough – Coughs that can be suppressed are less risky than uncontrollable coughs.
The risks and benefits must be weighed carefully for each individual patient. With precautions, many patients can undergo surgery safely despite a cough.
How might a cough affect surgery?
Coughs can influence surgery and anesthesia in a few key ways:
- Respiratory effects – Coughs irritate the airways and lungs, potentially leading to spasms, secretions, and reduced oxygen exchange.
- Airway management – Endotracheal intubation is harder with a cough and puts the lungs at further irritation.
- Anesthesia effects – Irritable airways make anesthesia administration more difficult and unpredictable.
- Post-op recovery – Coughing can be very painful after surgery and inhibit proper healing.
- Infectious spread – Viruses and bacteria can be dispersed by coughs, increasing infection risk.
These effects make coughs something to consider carefully before surgery. Doctors weigh if these risks can be managed or if it would be safer to postpone the procedure.
When would surgery be delayed due to a cough?
There are no universal guidelines on when to proceed or postpone surgery for a cough. Generally, surgery will be postponed in cases such as:
- Severe, uncontrolled coughs that have persisted for weeks.
- Coughs from respiratory infections like pneumonia, bronchitis, COPD exacerbations.
- Coughs affecting oxygen saturation levels.
- Coughs interrupting sleep and recovery.
- Coughs not responsive to medication treatment.
- Surgeries with long operating and anesthesia times.
- Cardiac, neurologic, thoracic surgeries where coughing poses high risks.
The risks of the surgery itself also factor in heavily. For simpler surgeries, like hernia repair, a minor cough is less concerning versus an open heart surgery where coughing could have grave complications.
What precautions allow surgery with a cough?
For mild coughs, these precautions are often taken to allow surgery to proceed:
- Administer cough suppressant medications before anesthesia and surgery to limit airway irritation.
- Use an endotracheal tube or laryngeal mask for airway control if intubation could worsen coughing.
- Adjust anesthesia dosage based on airway irritation and reactivity.
- Suction secretions frequently from the airway during surgery.
- Monitor oxygen saturation carefully through all phases.
- Shorten surgery time when possible to limit anesthesia effects.
- Use regional rather than general anesthesia if appropriate.
- Give additional medications to prevent nausea and vomiting exacerbating coughs.
- Prescribe cough medications and throat lozenges after surgery.
- Instruct patients to splint incisions when coughing.
Determining risks and benefits is highly individualized for the patient’s specific surgical needs. Caution is warranted, but a mild cough does not require outright surgery delays in most cases.
What risks remain with surgery and coughs?
Even with precautions, risks do remain when having surgery with coughs:
- Spasms or laryngospasm during intubation.
- Inadequate anesthesia levels due to hyperreactive airways.
- Hypoxemia or desaturation during procedures.
- Post-operative atelectasis and pneumonia.
- Aggravated coughing after extubation.
- Poor wound healing if coughing continues.
- Risk of transmitting respiratory infections to staff.
Careful monitoring of cough symptoms, oxygen levels, ventilation and vital signs during all perioperative phases is key. Some risk remains but can often be managed with proper anesthesia adjustments and cough control. However, uncontrolled coughs during delicate surgeries may necessitate postponing until cough resolves.
When can elective surgery be performed?
Elective surgeries are those scheduled in advance and medically necessary but not urgent. Examples include knee replacements, bariatric surgery, sinus surgery, plastic surgery. With elective surgeries, there is more leeway on timing compared to emergency surgery.
Surgeons typically prefer to wait until coughs resolve before proceeding with purely elective surgery. However, minor coughs may allow elective surgery as follows:
- Cough duration under 2 weeks
- No fever or influenza symptoms
- Normal oxygen saturation levels
- Cough responsive to medications
- Minimal sputum production
- Limited airway hyperreactivity
The risks and benefits will be weighed carefully for each patient’s specific elective surgery needs. Future surgery dates are rescheduled if the surgeon determines the cough poses too significant a surgical risk.
When is emergency surgery performed?
Emergency surgeries occur for immediate, life-threatening medical problems so they cannot be delayed easily. This includes urgent surgeries like appendectomies, brain hemorrhages, Caesar sections, and trauma surgeries.
With emergency surgeries, the risks of delaying likely outweigh the risks of operating with a cough:
- Surgeons have less ability to control timing.
- The medical problems often outweigh cough risks.
- Stopping coughs becomes a higher priority before surgery.
- Higher risk procedures may be required.
- Aggressive anesthesia and airway management are needed.
However, if the cough itself is the emergency medical problem requiring surgery, such as removing obstructing foreign material, resolving the cough may take priority first.
Special considerations for pediatric surgery
Performing surgery on pediatric patients with coughs requires additional caution. Children have higher risks of breathing complications during surgery and anesthesia. Key pediatric considerations include:
- Smaller airways are more easily obstructed by secretions and bronchospasms.
- Respiratory rates are faster so desaturation occurs sooner.
- Younger ages cannot comprehend instructions to suppress coughing.
- Higher risk of laryngospasm and bradycardia during anesthesia.
- Surface area impacts drug dosing of cough suppressants.
Non-urgent pediatric surgeries will often be postponed until coughs fully clear. Pediatric surgeons take extra precautions and adjust anesthesia carefully to mitigate risks. Parental consent discussions also ensure understanding of the increased cough-related risks to children during surgery.
Should coughs be treated before surgery?
Pre-operative cough treatment can help minimize risks during the surgery itself. Options may include:
- Cough suppressants – Oral medications like dextromethorphan or benzonatate.
- Mucolytics – Guaifenesin to thin mucus secretions.
- Expectorants – Promote productive coughs pre-operatively.
- Antihistamines/decongestants – Reduce post-nasal drip.
- Bronchodilators – Open airways in asthma, COPD.
- Steroids – Decrease airway inflammation.
- Antibiotics – Treat bacterial respiratory infections.
Starting treatment early before surgery allows time to see if cough improves. Intraoperative medications will also be given. The aim is to suppress the cough reflex as much as possible during surgery and immediately post-op when coughing is most detrimental.
What if cough starts right before surgery?
New cough symptoms developing shortly before scheduled surgery can be problematic. Surgeons typically recommend:
- Delay non-urgent surgery at least 2 weeks to allow cough to resolve.
- Proceed with urgent surgery but with added precautions.
- Prescribe cough medications immediately and use intraoperatively.
- Limit intubation time and use LMAs to reduce airway irritation.
- Highest priority on airway suctioning and oxygenation monitoring.
- Adjust medications based on airway reactivity noted after intubation.
- Extubate gently and avoid coughing on the endotracheal tube.
New coughs may still allow urgent surgery but Warrant extra preparations for airway management and anesthesia adjustments.
Conclusion
Having surgery with a cough can raise risks due to effects on respiration and recovery. However, mild intermittent coughs do not require outright delaying most surgeries. Doctors assess the severity, cause, duration and controllability of the cough alongside the urgency and type of surgery required. With proper preparations to optimize airway management, anesthesia administration and cough suppression, many patients can undergo surgery safely despite coughs. However, uncontrolled persistent coughs for cardiac or neurosurgeries may require postponing procedures until the cough resolves. Careful evaluation of risks allows life-saving surgery to proceed when necessary, even with coughs complicating the picture.
