Lung function after coronary artery surgery using the internal mammary artery and the saphenous vein.

Abstract

Lung volumes and arterial blood gas tensions in patients undergoing coronary artery surgery were compared in 77 patients given an internal mammary artery graft (group 1) and 33 patients given a saphenous vein graft only (group 2). Patients in both groups developed a severe restrictive ventilatory defect after surgery, more pronounced in those receiving an internal mammary artery graft. Mean (SEM) vital capacity in groups 1 and 2 was reduced to 36% (1-2%) and 45% (2-0%) of preoperative values on the second postoperative day (1-56 and 1-85 1 respectively), with some recovery by day 4 to 56% (1 2%) and 63% (2-1%) of preoperative values. The mean (SEM) arterial oxygen tension was 7-34 (0-13) kPa for group 1 and 7-46 (020) kPa for group 2 on day 2, rising to 8-39 (0-13) and 9-01 (023) kPa on day 4. Analgesic requirements were greater in the group receiving an internal mammary artery graft. Possible explanations for the differences between the effects of the two grafts include the higher frequency ofpleurotomy, the placing ofpleural drains, and additional surgical trauma when internal mammary artery grafts are used.

Miniesternotomia na cirurgia de revascularização miocárdica preserva função pulmonar pós-operatória

“…The present study demonstrated that, regardless of the sternal incision, there was an evident decrease in the early PO pulmonary function in the off-pump CABG surgery, an inevitable consequence reported by previous studies, which analyzed on-pump procedures [11][12][13][14] .…”

“…Moreover, the use of the LITA, which typically necessitates the insertion of a pleural drain, can be an adjuvant factor for PO pulmonary dysfunction [13][14][15] . …”

“…Although abundant evidence has shown a decrease in the pulmonary function in PO period of CABG surgery [11][12][13][14] , few studies had reported the influence of the dimension of the sternal incision on the pulmonary function. The important question and the objective of the study were to investigate whether the extension of the sternal incision could, alone, interfere with the pulmonary dysfunction observed in the PO period of CABG surgery.…”

Evaluation of Pulmonary Function after Off- Pump Coronary Artery Bypass Graft Surgery with Thoracic Epidural Analgesia.

“…Indeed, some reports have found that IMA patients have worse pulmonary functions than the RSVG patients in the postoperative period. 5 Basal atelectasis develops early during anaesthesia and may persist in the postoperative period. After surgery both respiratory muscles weakness and reduced, uncoordinated rib case expansion contribute to the restrictive ventilatory defect following median Sternotomy.…”

Early Post operative Pain Management and Early Extubation after Off-pump Coronary Artery Bypass Graft Surgery is better managed with Thoracic Epidural Analgesia

“…Indeed, some reports have found that IMA patients have worse pulmonary functions than the RSVG patients in the postoperative period. 5 Basal atelectasis develops early during anaesthesia and may persist in the post-operative period. After surgery both respiratory muscles …”