Prevention of respiratory complications after abdominal surgery

Abstract

Objective. To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus (BMJ 1996;312:148-53) Postoperative respiratory morbidity continues to be a tention), a stiffened abdominal wall and, possibly, diaphragmatic dysfunction. 1 These pathophysiological major factor in the utilisation of resources and maintenance of hospitalisation after major surgery. The inchanges underpin the events in the immediate postoperative period and morbidity and mortality depend troductory article draws attention to this but, as the aetiology, prevention and management are multiupon their severity. The main factor behind all these events, and the one which is most amenable to modfactorial, the approach of this review to this subject has been broadened. ulation, is severe postoperative pain. This discussion paper will review the effects of an The incidence of pulmonary complications is higher after upper abdominal or chest surgery than operations abdominal incision, its analgesic management, and postoperative physiotherapy on the generation of poston other parts of the body. These wounds produce a severe and prolonged alteration in pulmonary mechoperative respiratory complications. anics.1 Impaired ventilation and ineffective expectoration result in a postoperative failure of expansion or progression of collapse of lung segments, thereby encouraging infection. The ensuing shunt with venous Effects of anaesthesia and an abdominal incision on pulmonary physiology admixture results in hypoxaemia. Postoperative oxygen supply may therefore falter while oxygen demands are Some great minds have pondered the problem of postoperative complications. Pasteur, Haldane and Beecher increased due to metabolic hypermetabolism and hypercatabolism of the neuroendocrine stress response to were all convinced of the importance of active collapse of the lung after abdominal operations with shallow trauma.2 At the same time the work of breathing is increased due to the need for increased alveolar ventbreathing as the major cause of postoperative hypoxia and pulmonary complications.3-5

Transplante hepático: repercussões na capacidade pulmonar, condição funcional e qualidade de vida

“…As alterações fisiopatológicas registradas no PO (volumes e capacidades pulmonares reduzidos, alterações do padrão ventilatório e trocas gasosas) (12,13,17,19) são decorrentes das cicatrizes operatórias (22) e da disfunção diafragmática (17) . O ápice da disfunção ocorre no período entre 2 e 8 horas após a cirurgia, retornando aos valores pré-cirúrgicos em 7 a 10 dias, aproximadamente (12,13,17,24) , fato esse apresentado no presente estudo pelos pacientes no 1º mês após a realização da cirurgia.…”

“…Estudos sugerem que o TxH proporciona maior sobrevida e significativa melhora da QV para pacientes que possuem doença hepática em estágio terminal (1,5,18,26) . No entanto, outros pesquisadores demonstram que a permanência de sintomas físicos pós-transplante, como a baixa funcionalidade física e a redução da tolerância ao exercício (16,19) , além de complicações respiratórias decorrentes da cirurgia abdominal, podem estar presentes (24) . O objetivo do presente estudo foi avaliar e comparar a função pulmonar, a capacidade funcional e a qualidade de vida de pacientes candidatos e submetidos ao Tx no período de 1, 3, 6, 9, e 12 meses de pós-operatório (PO).…”

Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation

“…O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1,5,10,15,20,25, 30, 35 ,8; p=0,99). As variáveis foram expressas em média e desviopadrão.…”

“…All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1,5,10,15,20,25, 30, 35 Keywords: manual chest maneuver; mechanical ventilation; atelectasis; physical therapy. …”

Comparative study between injection parecoxib and butorphanol for postoperative analgesia in laparotomy patients

“…Pulmonary complications are known due to inadequate ventilation and retention of secretions if pain is not relieved. 2 Hence management of pain is a must in postoperative period after thoracic and abdominal surgeries.…”