The effect of posture on late postoperative oxygenation

Abstract

SummaryTwelve patients had their arterial oxygen saturation measured pre-operatively and on days 1 , 4 and 7 after laparotomy.Measurements were performed in the supine, sitting and standing positions on each day. Arterial oxygen saturation was significantly higher during sitting and standing on days 1 and 4 after operation compared with the supine position dp < 0.05).These results give further evidence for the benefits of patient mobilisation after major surgery. Key wordsComplications; postoperative, hypoxia. Position.It is well established that pulmonary function deteriorates after major surgery with a maximum decrease in functional residual capacity (FRC) at approximately 16 h after operation and a gradual recovery towards pre-operative levels during the first postoperative week [l]. Similarly, the effect of posture on pulmonary mechanics is known to decrease FRC in the supine compared to the sitting position [2]. As hypoxaemia may be a pathogenic factor in postoperative organ dysfunction [3-91 and since many postoperative patients stay in the supine or semirecumbent position after major operations, we decided to study the effect of posture on oxygenation in the late postoperative period. MethodsTwelve patients gave their informed consent to be included in the study which had received local ethics committee approval. All patients were scheduled for major intraabdominal surgery. None of the patients was receiving any regular medication before operation and patients with thoracic deformities or symptoms of neurological, cardiac or respiratory disease were not studied. If patients subsequently required supplemental oxygen therapy later than 6 h after operation they were withdrawn from the study. All patients received a standard general anaesthetic regimen (thiopentone, midazolam, low-dose fentanyl, suxamethonium, pancuronium and nitrous oxide in oxygen), and postoperative analgesia was provided with morphine or ketomebidone 5-1 0 mg given intramuscularly on demand. Regional anaesthesia was not used during the per-and postoperative period.Arterial oxygen saturation (Spoz) was monitored with a pulse oximeter (Nellcor N-200, Nellcor Inc., Pleasanton, CA, USA) using an adhesive finger probe for three periods of 10 min, on each day of monitoring. The mean Spo, for each 10-min period was used in the data analysis. The monitoring periods were conducted with the patient in the supine position, sitting in bed (70") and standing. Before any measurements were made the patient had rested for 30 min in bed. Measurements were performed pre-operatively and 1, 4 and 7 days after operation and were always performed in the afternoon. At the same time, pulmonary function was assessed by measurement of peak expiratory flow (PEF), forced vital capacity (FVC) and forced expiratory volume in the first second (FEV,) using a mini Wright's respirometer and a Vitalograph. For the pulmonary function tests the patient was always in the sitting position. On every day of the study pain scores (verbal rating, 0 = no pain, 1 =discomfort, 2 = sl...

Early Versus Traditional Postoperative Feeding in Patients Undergoing Resectional Gastrointestinal Surgery

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Should Patients Walk From the Postanesthesia Care Unit to the General Ward After a Lumbar Discectomy? A Randomized Study

“…The time to first mobilization thereafter was 35 minutes (20-270) in the intervention group and 180 minutes (10-245) in the control group. During the first 24 hours in the GW, the patients in the two groups left their beds nine times (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) and seven times (4-11), respectively and were out of their beds for 171 minutes (50-670) and 210 minutes (90-420), respectively. Patients in the intervention group were hospitalized for 27 hours (21-32) and patients in the control group for 25 hours (21-49).…”

“…It is well documented that early mobilization after surgery, as well as an increased time out of bed each day, reduce the patient's risk of postoperative complications and improves their well-being. [8][9][10][11][12] Despite this, the early mobilization has been limited to the general ward (GW). Symptoms such as nausea, vomiting, pain, dizziness, and fainting may hinder early mobilization.…”

Colorectal Cancer in the Elderly

“…The positional change from supine to upright increases functional residual capacity signi fi cantly to reverse atelectasis and positively alters lung mechanics and fl ow rates ( Wiren et al 1983 ;Mynster 1996 ;Nielsen et al 2003 ) . The positional change from supine to upright increases functional residual capacity signi fi cantly to reverse atelectasis and positively alters lung mechanics and fl ow rates ( Wiren et al 1983 ;Mynster 1996 ;Nielsen et al 2003 ) .…”