Perioperative respiratory physiology

Weissman, Charles

doi:10.1016/0883-9441(91)90007-g

Cited by 7 publications

(3 citation statements)

References 111 publications

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“…After upper abdominal surgery, diaphragmatic excursion is decreased, and paradoxical motion of the diaphragm can occur [13]. Irritation of the phrenic nerve, distension of the anterior abdominal muscles, and inhibition of the diaphragm cause a decrease in vital capacity, alveolar hypoventilation, and a reduction in the amount of sighing [14]. For laparoscopic procedures, CO 2 can form a residue under the diaphragm and can cause irritation of the phrenic nerve.…”

Section: Discussionmentioning

confidence: 99%

Influence of Preemptive Analgesia on Pulmonary Function and Complications for Laparoscopic Cholecystectomy

2009

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Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

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Section: Discussionmentioning

confidence: 99%

Influence of Preemptive Analgesia on Pulmonary Function and Complications for Laparoscopic Cholecystectomy

2009

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“…Furthermore, a variety of physiological alterations occur in the immediate postoperative period that further increase the patient's susceptibility to pulmonary infection. 21 Following thoracic and upper abdominal incisions, the vital capacity (VC) decreases by 50 to 70% over the ensuing 18 hours, 22,23 with similar changes in the functional residual capacity (FRC), forced expiratory volume in one second (FEV 1 ), and maximum inspiratory and expiratory pressure. 21 When the FRC decreases to less than the closing volume, alveolar air trapping with inefficient gas exchange occurs, followed by resorption and atelectasis.…”

Section: Early Pneumoniamentioning

confidence: 99%

“…21 Following thoracic and upper abdominal incisions, the vital capacity (VC) decreases by 50 to 70% over the ensuing 18 hours, 22,23 with similar changes in the functional residual capacity (FRC), forced expiratory volume in one second (FEV 1 ), and maximum inspiratory and expiratory pressure. 21 When the FRC decreases to less than the closing volume, alveolar air trapping with inefficient gas exchange occurs, followed by resorption and atelectasis. Incisions that simultaneously violate the abdominal and thoracic cavities, or that divide a portion of the diaphragm further worsen these mechanical changes, and are associated with considerable pain during the recovery period leading to splinting and shallow breathing.…”

Section: Early Pneumoniamentioning

confidence: 99%

Hospital-Acquired Pneumonia in the Postoperative Setting

Yaffe¹,

Fink²

1997

Semin Respir Crit Care Med

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Hospital-acquired pneumonia in the postoperative or trauma patient is a common and troublesome complication. A variety of patient factors such as smoking, chronic obstructive pulmonary disease (COPD), morbid obesity, and poor overall medical condition, along with therapeutic interventions such as abdominal and thoracic operations, the need for prolonged intubation and mechanical ventilation, and postoperative changes in respiratory mechanics increase the risk for nosocomial pneumonia in surgical patients. Establishing the diagnosis of hospital-acquired pneumonia in this group of patients is notoriously difficult, since systemic signs of inflammation and radiographic changes of atelectasis or chest trauma that mimic infectious infiltrates are common. Early-onset and late-onset pneumonia in these patients have different associated risk factors, microbiology, and prognosis. Late-onset pneumonia in both postoperative and trauma patients is associated with significant mortality. A variety of preventive measures such as selective digestive decontamination, continuous postural oscillation, and preoperative respiratory muscle training may be beneficial in selected circumstances.

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