Effects of Upper or Lower Abdominal Surgery on Diaphragmatic Function

Bertrand, Denis; Cantineau, J. P.; Jm, Desmonts

doi:10.1093/bja/59.10.1230

Cited by 140 publications

(74 citation statements)

References 13 publications

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“…The reduction in the pulmonary function is the result of the combination of several factors, including the general anesthesia, median sternotomy, cardiopulmonary bypass (CPB) [2] and diaphragmatic dysfunction [10]. As well as these, there is the additional factor of the pleural drainage required because of the use of LITA grafts with pleurotomy [3,11].…”

Section: Discussionmentioning

confidence: 99%

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

Guizilini¹,

Gomes²,

Faresin³

et al. 2004

Braz. j. cardiovasc. surg.

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Objective: To analyze pulmonary functional changes and pain in patients undergoing off-pump coronary artery bypass grafting utilizing a left internal thoracic artery graft, comparing pleural drain insertion through the intercostal space and the subxyphoid approach.Methods: Twenty-eight patients (mean age 57.4 ± ± ± ± ± 8.4 years) were divided into two groups, according to the pleural drain site. Group LI (n=15) had the pleural drain inserted through the sixth left intercostal space at the mid-axillary line and in the MI group (n=13) the drain was placed through the subxyphoid region. All the patients underwent pre-and postoperative evaluations of pulmonary function tests as well as arterial blood gas analysis. Forced vital capacity (FVC) and forced expiratory volume over one second (FEV 1 ) were recorded in the preoperative period, and on the first, third and fifth postoperative days. The pain sensation was evaluated using a standard score from 0 to 10. Results:In both groups, falls in the FVC and FEV 1 were noted, up to the fifth postoperative day (P<0.001). However the decrease was higher in the LI group, when compared to the MI group (p<0.05). Also arterial blood gas analysis showed a decline of the partial oxygen pressure in both groups on the first postoperative day, but more significantly in the LI group (p=0.021). The pain sensation was higher in the LI group (p=0.002).Conclusion: Off-pump coronary artery bypass grafting using the left internal thoracic artery, disregarding the pleural drain site, leads to a significant decrease of postoperative pulmonary function. However, the subxyphoid technique of drain insertion has shown a better preservation of the lung function when compared to the intercostal drain site.Descriptors: Coronary artery bypass surgery. Pleural drain. Pulmonary function. 48GUIZILINI, S ET AL -Effects of the pleural drain site on the pulmonary function after coronary artery bypass grafting Bras Cir Cardiovasc 2004; 19(1): 47-54 Rev

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Section: Discussionmentioning

confidence: 99%

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

Guizilini¹,

Gomes²,

Faresin³

et al. 2004

Braz. j. cardiovasc. surg.

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“…Despite recent advances in preoperative management, postoperative respiratory morbidity is still a common problem, especially following upper abdominal surgery. [1][2][3][4][5][6] The main risk factors that have been associated with PPCs are: smoking, chronic obstructive pulmonary disease, advanced age, site and duration of surgery, obesity and comorbidity. [7][8][9][10][11][12][13] The preoperative evaluation should include steps to prepare patients for surgery and to identify those at high risk for developing complications, thus allowing physicians to take prophylactic measures to reduce the incidence of PPCs.…”

Section: Introductionmentioning

confidence: 99%

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

et al. 1999

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Objective: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. Design: Prospective clinical trial. Setting: A tertiary university hospital. Patients: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. Measurements: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. Results: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). Conclusions: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient's pulmonary status. Key words: abdominal surgery, risk factor, morbidity Abbreviations: BMI = body mass index; FEV1/FVC = forced expiratory volume in the first second divided by forced vital capacity; PPC = postoperative pulmonary complication. respiratory infections, bronchoconstriction and respiratory failure. 3,11,12 Preoperative spirometric tests have been reported to be reliable predictors of PPCs. However, the risk of PPCs is usually estimated in heterogeneous populations and in various surgical procedures, 1,13,14 making it difficult to ascertain the relationship between PPCs and previous spirometric abnormalities. The aim of this study was to follow prospectively a group of patients undergoing an elective upper abdominal surgery to identify those factors associated with an increased risk of developing PPCs using a standard preoperative evaluation. In addition, a subgroup of these patients was submitted to spirometr y to investigate the importance of this test as a predictor of PPCs in this population. Original Article METHODSThis study was performed on 408 consecutive patients undergoing elective abdominal surgery at the Federal University of São Paulo's teaching hospital. All patients were referred for a preoperative assessment (between January 1992 and December 1992), after having been scheduled for elective upper abdominal surgery. All were operated on and observed at the same hospital.Of the 408 patients, 206 were men and 202 were women and their mean age was 55 + 15 years. Operative procedures are...

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“…Age is an important predictive factor for complications after cholecystectomy due to the increased incidence of complicated gallbladder disorder and higher morbididy of According to the literature, pulmonary complications in the post-operative period of conventional abdominal surgery usually range from 30% to 80% 20,21 . In laparoscopic cholecystectomy the most expected pulmonary complication on the days immediately after surgery is atelectasis, which varies in 10% to 35% of incidence 4 .…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

et al. 2014

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PURPOSE:To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS:Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. RESULTS:BMI average was 28.8±4.8 kg/m 2 . Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers.There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. CONCLUSION:Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.

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Effects of Upper or Lower Abdominal Surgery on Diaphragmatic Function

Cited by 140 publications

References 13 publications

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

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