Pulmonary Function and Thoraco-abdominal Configuration After Elective Craniotomy

Franceschini, Juliana; Sogame, L Cm; Gazzotti, Mariana Rodrigues; Vidotto, Milena Carlos; Jardim, José R.

doi:10.1097/wnq.0b013e3181642714

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…This hypothesis was studied in 47 patients undergoing craniotomy under anesthesia. [6] The investigators concluded that patients who underwent elective craniotomy may present in the postoperative period with altered respiratory mechanics. In this study, a longer duration of anesthesia was found to translate into higher rate of POPCs ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…[5] One plausible explanation for the increased risk is decrease in lung volumes and arterial blood gas tensions with concomitant change in respiratory pattern that occurs after craniotomy. [6] Patients undergoing posterior fossa surgery are at an even higher risk of developing POPCs because of the interplay of other mechanisms like mechanical obstruction, central respiratory dysfunction, and neuromuscular dysfunction. [7] Obstructive sleep apnea has been reported in association with posterior fossa lesions.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

Hooda

Chouhan

Rath

et al. 2019

J Anaesthesiol Clin Pharmacol

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Background and Aims: Infratentorial neurosurgical procedures are considered high risk for the development of postoperative pulmonary complications (POPCs), prolonging hospital stay of patients with substantial morbidity and mortality. Material and Methods: Patients between the ages of 18 and 65 years, who underwent elective surgery for posterior fossa tumors over a period of two years, were reviewed. Data including American Society of Anesthesiologists physical status; comorbidities like hypertension, diabetes mellitus and hypothyroidism, history of smoking, obstructive sleep apnea, respiratory symptoms, lower cranial nerve (LCN) palsy; intraoperative complications such as hemodynamic alterations suggestive of brain stem or cranial nerve handling, tight brain as informed by the operating neurosurgeon, blood loss, and transfusion; and postoperative duration of mechanical ventilation, tracheostomy, POPCs, length of ICU and hospital stay, general condition of the patient at discharge, and cause of in-hospital mortality were collected. POPC was defined as the presence of atelectasis, tracheobronchitis, pneumonia, bronchospasm, respiratory failure, reintubation, or weaning failure. Results: Case files of 288 patients fulfilling the study criteria were analyzed; POPCs were observed in 35 patients (12.1%). On multivariate analysis, postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy were found to be independent predictors of POPC. Conclusions: The incidence of POPC was 12.1% following infratentorial tumor surgery. The predictors for the occurrence of POPCs were postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

Hooda

Chouhan

Rath

et al. 2019

J Anaesthesiol Clin Pharmacol

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“…10 To the best of our knowledge, only one previous study has evaluated lung function in adult patients undergoing laminectomy to treat disc herniation or tumors. 11 The changes to lung function and the behavior of the respiratory muscles were similar to those seen during the postoperative period following thoracoabdominal 4 and cranial 8,9 surgery. Alterations to respiratory function, such as reduction of lung volumes and respiratory muscle strength during the postoperative period following elective spinal surgery using a posterior access for tumor removal or herniated disc were correlated with surgical duration ≥ 240 minutes, presence of tumors, or cervicothoracic surgical access.…”

Section: Introductionmentioning

confidence: 50%

“…The reduction in inspiratory muscle strength suggests that lengthy surgery accentuates the inhibition of the diaphragm reflex, independent of the location of the surgery. 8,9,23 Reduction in respiratory muscle strength is related to diminished lung function and an increase in the incidence of pulmonary complications in patients who undergo surgery. 24 The overall reductions in MIP of 52.8% and 51.7% on the first and second postoperative days, respectively (P < 0.001), were similar to the MIP reduction found following upper abdominal surgery, 24,25 and much higher than the 18% reduction in MIP expected for laminectomy of the lumbar spine.…”

Section: 20mentioning

confidence: 99%

“…These patients experience reduction in lung volume, changes to respiratory patterns (from predominantly diaphragmatic to intercostal), hypoxemia and reduction in mucociliary transport. 8,9 Other factors can contribute to the reduction in pulmonary volumes, such as general anesthesia, pain, immobility in bed and supine position. 5,6 Up to 95% of patients with normal lungs who undergo general anesthesia may present atelectasis, which persists for more than 24 hours in 50% of the cases.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery

et al. 2015

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Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgeryAvaliação dos volumes pulmonares, capacidade vital e força dos músculos respiratórios no pós-operatório de cirurgia na coluna cervical, torácica e lombar Marcio Aparecido Oliveira I , Milena Carlos Vidotto II , Oliver Augusto Nascimento III , Renato Almeida IV , Ilka Lopes Santoro V , Evandro Fornias Sperandio VI , José Roberto Jardim VII , Mariana Rodrigues Gazzotti VIII Universidade Federal de São Paulo ABSTRACTCONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.RESUMO CONTEXTO E OBJETIVO: Estudos têm demonstrado que alterações fisiopatológicas no sistema respirató-rio podem ocorrer após cirurgia torácica e abdominal. A laminectomia é considerada uma cirurgia perifé-rica, mas é possível que as cirurgias de coluna torácica exerçam maior influência sobre a função pulmonar. O objetivo do estudo foi avaliar os volumes pulmonares e as pressões respiratórias máximas em pacientes submetidos a cirurgia de coluna cervical, torácica ou lombar. TIPO DE ESTUDO E LOCAL: Estudo prospectivo em hospital universitário terciário. MÉTODOS: Sessenta e três pacientes submetidos a laminectomia com diagnóstico tumor ou hérnia de disco foram avaliados. Foram avaliados, no pré-operatório, no primeiro e no segundo ...

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Pulmonary Function After Surgery for Congenital Atlantoaxial Dislocation

Reddy

Devi

et al. 2009

Journal of Neurosurgical Anesthesiology

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Deterioration of pulmonary function after surgery for congenital atlantoaxial dislocation (AAD) has been documented in a few studies. We proposed that this deterioration in AAD is much higher than what can be expected after a surgical procedure under general anesthesia or what occurs after any surgery on the cervical spine. To test this hypothesis, we recorded forced vital capacity (FVC), forced expiratory ratio (FEV 1.0), forced expiratory flow (FEF 25%-75%) and muscle power in the extremities in 25 patients undergoing surgical correction of AAD (AAD group), 29 patients undergoing surgery for compressive cervical spine lesions (cervical spine group) and 20 patients undergoing craniotomy for an intracranial lesion (craniotomy group). The observations were made before surgery and on postoperative days 1 and 7. The demographic characters were comparable among the 3 groups. All patients underwent an uneventful surgery and their trachea was extubated in the operating room. There was no decrease in the muscle power in the postoperative period in any of the groups. A significant decrease in FVC (expressed as percentage of the predicted value) was seen postoperatively in all the 3 groups. The reduction of FVC was significantly different among the groups, with the AAD group having the lowest values (P<0.001). The FVC values in the AAD group were 74.6+/-19.6%, 49.6+/-17.7%, 64.0+/-20.8% at baseline, on postoperative days 1 and 7, respectively (P<0.001). Postoperative change in forced expiratory ratio was also significantly different among the groups (P=0.03). A significant difference was found between the AAD and cervical spine group (89.8+/-8.3%, 88.2+/-17.6%, 89.3+/-9.8% in the AAD group and 95.5+/-20.5%, 78.4+/-13.4%, 72.7+/-19.1% in the cervical spine group at baseline and on postoperative days 1 and 7, respectively, P<0.05). FEF 25%-75% changes were also significantly different among the groups (P<0.001). The decrease in the AAD and cervical spine groups was significantly higher than that in the craniotomy group (P<0.001). In conclusion, during the first week after surgery, deterioration of pulmonary function in the AAD group is significantly different from that seen in patients undergoing surgery for compressive cervical lesions or craniotomy for a cerebral lesion. The data imply the need for special attention to respiratory function in patients operated for AAD in the postoperative period.

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Pulmonary Function and Thoraco-abdominal Configuration After Elective Craniotomy

Cited by 5 publications

References 30 publications

Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery

Pulmonary Function After Surgery for Congenital Atlantoaxial Dislocation

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