Diaphragm Function after Upper Abdominal Surgery in Humans^1–3

Abstract

Patients undergoing upper abdominal surgery characteristically develop changes in lung function and are liable to develop atelectasis in the lower lobes. We studied 15 patients to assess lung function and, in particular, diaphragm function in patients undergoing cholecystectomy. Postoperatively, forced expiratory volume in one second and vital capacity decreased in all patients. The alveolar-arterial oxygen difference widened in the 10 patients in whom it was measured. Chest roentgenograms demonstrated patchy atelectasis in 9 of the 10 patients in whom films were obtained. There was a significant reduction in tidal volume with no change in minute ventilation immediately postoperatively. Diaphragm function was assessed by: changes in transdiaphragmatic pressure swings during quiet tidal breathing, the ratio of changes in gastric to esophogeal pressure swings, and the ratio of changes in abdominal to rib cage diameters. The results showed a significant decrease in changes in transdiaphragmatic pressure and the ratio of changes in gastric to esophogeal pressure swings in the postoperative period. In the 4 patients studied with magnetometers, there was a reduction in the ratio of changes in abdominal to rib cage diameters in all patients. These data indicate reduced diaphragm activity in the postoperative period, with a shift from predominantly abdominal to rib cage breathing. There was a reversal toward normal function by 24 h. This reduction in diaphragm function may be responsible for the atelectasis, reduced vital capacity, and hypoxemia in postoperative patients.

Perioperative functional residual capacity

“…The reflex inhibition may be voluntarily overridden . 96 The restoration of lung function by epidural analgesia is limited. 94'95 There is no difference in serial measurements of vital capacity and blood gases between epidural analgesia and parenteral morphine after abdominal cancer operations.…”

Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy

“…Furthermore, anesthesia can cause neuromuscular blockade and a reduction in respiratory muscle contraction. Ford et al 21 suggested diaphragmatic dysfunction to be due to direct secondary injury to the abdominal muscles, causing mechanical failure and pain at the incision site which contribute to respiratory alterations. Ayoub et al 22 also reported a decrease in diaphragmatic excursion during the course of upper abdominal surgeries due to surgical incision, reducing the inspiratory amplitude, especially in conventional cholecystectomy.…”

L’obésité, l’analgésie péridurale et l’incision sous-costale sont des facteurs de risque de désaturation postopératoire

“…Reduction of functional residual capacity causes early postoperative hypoxemia, as the combined effect of pain from the incision and temporary diaphragm dysfunction. [1][2][3][4]23 Currently, there is no standard definition regarding episodic hypoxemia. We modified the definition from Rosenberg et al…”

“…Constant desaturation lasts for a few minutes and has been attributed mainly to a decrease of functional residual capacity by atelectasis, microatelectasis, reduction of diaphragm and intercostal muscle activity, residual anesthetic drugs, and postoperative pain limiting deep breathing. [1][2][3][4] The second type of desaturation is episodic nocturnal desaturation that may be related to disruption of the normal sleep pattern induced by stress and the physiologic alterations due to anesthesia and surgery. 5,6 Both conditions frequently occur on the second postoperative day and may last longer than one week postoperatively.…”