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Poliacek I, Martvon L, Simera M, Veternik M, Misek J, Cibulkova L, Iceman KE, Bolser DC, Pitts T. Cough and swallow after laparotomy in anesthetized cats. Respir Physiol Neurobiol 2024; 319:104179. [PMID: 37858661 DOI: 10.1016/j.resp.2023.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
An anesthetized cat animal model was used to evaluate changes in cough and swallow after a small midline upper abdominal incision (laparotomy). Two additional conditions were tested: sealing the laparotomy with gentle suctioning via a small cannula, and subsequent closure of the abdominal wall with suture. These abdominal wall manipulations resulted in no changes in the cough reflex, but produced higher motor drive to pharyngeal musculature (thyropharyngeus and geniohyoid muscles) during swallow. Swallow-breathing coordination phase preference shifted towards swallow occurring more during the inspiratory phase. There were no significant changes in cough motor pattern, or cough and swallow number and temporal features. The respiratory changes were limited to reduced inspiratory motor drive to the diaphragm. The results are consistent with an important role of sensory feedback from the abdominal wall in regulation of swallow motor pattern. The level of reflex modulation may depend on the extent of injury and likely on its position in the abdomen.
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Affiliation(s)
- Ivan Poliacek
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic
| | - Lukas Martvon
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic; Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Medical Education Support Center, Martin, Slovak Republic.
| | - Michal Simera
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic
| | - Marcel Veternik
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic
| | - Jakub Misek
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic
| | - Lucia Cibulkova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601 Martin, Slovak Republic
| | - Kimberly E Iceman
- Department of Speech Language Hearing Sciences, Dalton Cardiovascular Center, University of Missouri, Columbia, MO, USA
| | - Donald C Bolser
- Dept. of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Teresa Pitts
- Department of Speech Language Hearing Sciences, Dalton Cardiovascular Center, University of Missouri, Columbia, MO, USA
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Imperatore F, Gritti F, Esposito R, del Giudice C, Cafora C, Pennacchio F, Maglione F, Catauro A, Pace MC, Docimo L, Gambardella C. Non-Invasive Ventilation Reduces Postoperative Respiratory Failure in Patients Undergoing Bariatric Surgery: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1457. [PMID: 37629747 PMCID: PMC10456476 DOI: 10.3390/medicina59081457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Postoperative non-invasive ventilation (NIV) has been proposed as an attractive strategy to reduce morbidity in obese subjects undergoing general anaesthesia. The increased body mass index (BMI) correlates with loss of perioperative functional residual capacity, expiratory reserve volume, and total lung capacity. The aim of the current study is to evaluate the efficacy of NIV in a post-anaesthesia care unit (PACU) in reducing post-extubation acute respiratory failure (ARF) after biliointestinal bypass (BIBP) in obese patients. Materials and Methods: A retrospective analysis was conducted from January 2019 to December 2020 to compare acute respiratory failure within the first 72 postoperative hours and oximetry values of obese patients who underwent BIBP after postoperative NIV adoption or conventional Venturi mask. Results: In total, 50 patients who received NIV postoperative protocol and 57 patients who received conventional Venturi mask ventilation were included in the study. After 120 min in PACU pH, pCO2, pO2, and SpO2 were better in the NIV group vs. control group (p < 0.001). Seventy-two hours postoperatively, one patient (2%) in the NIV group vs. seven patients (12.2%) in the control group developed acute respiratory failure. Therefore, conventional Venturi mask ventilation resulted in being significantly associated (p < 0.05) with postoperative ARF with an RR of 0.51 (IC 0.27-0.96). Conclusions: After bariatric surgery, short-term NIV during PACU observation promotes a more rapid recovery of postoperative lung function and oxygenation in obese patients, reducing the necessity for critical care in the days following surgery. Therefore, as day-case surgery becomes more advocated even for morbid obesity, it might be considered a necessary procedure.
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Affiliation(s)
- Francesco Imperatore
- Unit of Anaesthesia and Intensive Care, “San Giovanni di Dio Hospital” Frattamaggiore, 80020 Naples, Italy
| | - Fabrizio Gritti
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Rossella Esposito
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Claudia del Giudice
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Chiara Cafora
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Francesco Pennacchio
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Francesco Maglione
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Antonio Catauro
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Maria Caterina Pace
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
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Rovira L, Kot P, Pozo S, Cano B, De Andrés J. Peri-operative Hemi-diaphragmatic Variations After Brachial Plexus Block Above the Clavicle: A Prospective Observational Study of the Contralateral Side. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00175-8. [PMID: 37394374 DOI: 10.1016/j.ultrasmedbio.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Hemi-diaphragm palsy after brachial plexus block above the clavicle (BPBAC) occurs frequently, but few patients develop post-operative pulmonary complications (PPC). We hypothesized that contralateral hemidiaphragm function increases after BPBAC. This contralateral function preserves global diaphragmatic function, avoiding PPC in the case of ipsilateral hemi-diaphragm palsy. METHODS This prospective observational cohort study included 64 adult patients undergoing shoulder surgery with planned BPBAC (interscalene brachial plexus block and supraclavicular block). The Thickening Fraction (TF) was measured by ultrasound in both hemi-diaphragms, ipsilateral (TF ipsilateral) and contralateral (TFcontralateral) to the BPBAC, before and after the surgery. TFglobal is the sum of TFipsilateral and TFcontralateral. PPC were defined as occurrences of dyspnea, tachypnea, SpO2 <90% or SpO2/FiO2 <315. RESULTS TFcontralateral increased significantly (an average of 40%) after BPBAC (p = 0.001), and TFipsilateral decreased (an average of 72%). After BPBAC, 86% of patients had a decreased TFipsilateral and 59% of patients an increased TFcontralateral at post-operatively. Only 17% of patients have PPC. CONCLUSION After BPBAC, global diaphragm function decreases because of ipsilateral hemi-diaphragm reduction, but less than expected because of increased contralateral hemi-diaphragm function. As a part of diaphragm function, contralateral hemi-diaphragm function must be checked.
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Affiliation(s)
- Lucas Rovira
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain.
| | - Pablo Kot
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
| | - Silvia Pozo
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Beatriz Cano
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - José De Andrés
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
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Ganapathy A, Ballard DH, Bishop GL, Hoegger MJ, Abraham N, D’Agostino HB. Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage. APPLIED SCIENCES (BASEL, SWITZERLAND) 2023; 13:7308. [PMID: 37621554 PMCID: PMC10448541 DOI: 10.3390/app13127308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Grace L. Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark J. Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - Horacio B. D’Agostino
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
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Xu Y, Ye M, Liu F, Hong Y, Kang Y, Li Y, Li H, Xiao X, Yu F, Zhou M, Zhou L, Jiang C. Efficacy of prolonged intravenous lidocaine infusion for postoperative movement-evoked pain following hepatectomy: a double-blinded, randomised, placebo-controlled trial. Br J Anaesth 2023:S0007-0912(23)00169-1. [PMID: 37202261 DOI: 10.1016/j.bja.2023.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The analgesic effect of intravenous lidocaine varies with the duration of lidocaine infusion and surgery type. We tested the hypothesis that prolonged lidocaine infusion alleviates postoperative pain in patients recovering from hepatectomy over the first 3 postoperative days. METHODS Patients undergoing elective hepatectomy were randomly assigned to receive prolonged i.v. lidocaine treatment or placebo. The primary outcome was incidence of moderate-to-severe movement-evoked pain at 24 h postoperatively. The secondary outcomes included incidence of moderate-to-severe pain during movement and at rest throughout the first 3 postoperative days, postoperative opioid consumption, and pulmonary complications. Plasma lidocaine concentration was also monitored. RESULTS We enrolled 260 subjects. Intravenous lidocaine lowered the incidence of moderate-to-severe movement-evoked pain at 24 h and 48 h postoperatively (47.7% vs 67.7%, P=0.001; 38.5% vs 58.5%, P=0.001) and reduced movement-evoked pain scores (3.7 [1.7] vs 4.2 [1.6]; mean difference 0.5 [95% confidence interval {CI}: 0.1-0.9]; P=0.018) and morphine equivalent consumption (47.2 [16.7] mg vs 52.6 [19.2] mg; mean difference 5.4 mg [95% CI: 1.0-9.8]; P=0.016) at 24 h postoperatively. Lidocaine also lowered the incidence of postoperative pulmonary complications (23.1% vs 38.5%; P=0.007). Median plasma lidocaine concentrations were 1.5, 1.9, and 1.1 μg ml-1 (inter-quartile ranges: 1.1-2.1, 1.4-2.6, and 0.8-1.6, respectively) after bolus injection, at the end of the surgery, and 24 h postoperatively. CONCLUSIONS Prolonged intravenous lidocaine infusion reduced the incidence of moderate-to-severe movement-evoked pain for 48 h after hepatectomy. However, the reduction in pain scores and opioid consumption by lidocaine was below the minimal clinically important difference. CLINICAL TRIAL REGISTRATION NCT04295330.
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Affiliation(s)
- Yan Xu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Mao Ye
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fei Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying Hong
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yi Kang
- Department of Anaesthesiology and Translational Neuroscience Centre, Laboratory of Anaesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Li
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Huan Li
- Department of Anaesthesiology, Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Xiao Xiao
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Feng Yu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Mengmeng Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Li Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Chunling Jiang
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
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Asada M, Nobukuni K, Yoshino J, Fujimura N. Comparison of Changes in Chest Wall Mechanics and Respiratory Timing Between Patient-Controlled Epidural Analgesia and Intravenous Patient-Controlled Analgesia After Laparoscopic Gastrectomy: A Randomized Controlled Trial. Cureus 2023; 15:e37276. [PMID: 37168150 PMCID: PMC10165419 DOI: 10.7759/cureus.37276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Upper abdominal surgery is associated with postoperative diaphragmatic dysfunction. Whether patient-controlled epidural analgesia (PCEA) is superior to intravenous patient-controlled analgesia (IV-PCA) in preventing postoperative diaphragmatic dysfunction is still unclear in laparoscopic gastric surgery. METHODS Sixteen patients undergoing laparoscopic gastrectomy randomly received either PCEA or IV-PCA. The primary outcomes were the change in chest wall mechanics and respiratory timing, measured by respiratory inductive plethysmography (Respitrace; Ambulatory Monitoring Inc., Ardsley, New York, United States) before and after surgery, and analyzed by a data acquisition system (PowerLab; ADInstruments, Dunedin, New Zealand). Inspiratory time (Ti), expiratory time (Te), total respiratory cycle time (Ttot), proportion of inspiratory time over total respiratory cycle time (Ti/Ttot), respiratory rate (RR), and abdominal contribution to tidal volume (AB/VT [%]) were calculated from the stored data. AB/VT, relative volume contribution of diaphragm to tidal breathing, represents an index of diaphragmatic function. Because the diaphragm is the main contributor to tidal volume, decreases in AB/VT indicate diaphragm dysfunction. Changes in outcomes over time between the two groups were analyzed using a linear mixed model, and two-sided p values < 0.05 were considered statistically significant. The secondary outcomes were postoperative pain score (visual analog scale (VAS)), bowel function recovery, and hospital stay duration. RESULTS Postoperative AB/VT in the IV-PCA group was significantly decreased compared to preoperative levels. AB/VT in the PCEA group was significantly higher than the IV-PCA group on postoperative day (POD) 1. Change in AB/VT over time between the PCEA group and the IV-PCA group differed significantly (p = 0.01). A decrease of AB/VT during POD 1 to 3 was observed in the IV-PCA group but not in the PCEA group. As for respiratory timing, there were significant increases in RR with a reduction of Te and Ttot compared to preoperative levels on POD 1 in the PCEA group. There were significant decreases in RR and Ti/Ttot with an increase of Te and Ttot compared to preoperative levels on POD 1 in the IV-PCA group. There was a significant difference in the change of the Ttot over time between the two groups (p = 0.046). There were no significant differences in the changes of Te, Ti/Ttot, Ti, and RR over time between the two groups. There was no significant difference in VAS over time at rest and mobilization, recovery of bowel function, and hospital stay between the two groups. CONCLUSIONS Continuous ropivacaine infusion with PCEA partially attenuated diaphragmatic dysfunction after laparoscopic gastrectomy, while pain relief by continuous intravenous administration of fentanyl could not attenuate diaphragmatic dysfunction. This suggests that PCEA might ameliorate postoperative diaphragmatic dysfunction after laparoscopic gastrectomy.
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Affiliation(s)
- Masako Asada
- Anesthesiology, Kyushu University Hospital, Fukuoka, JPN
| | - Keiko Nobukuni
- Anesthesiology, Kyushu University Hospital, Fukuoka, JPN
| | - Jun Yoshino
- Anesthesiology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, JPN
| | - Naoyuki Fujimura
- Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, JPN
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Daniel M, Lang E, Huynh TM, Martin J, Brebion M, Guessous K, Zlotnik D, Gouzien L, Chaouch O, Delval P, Ferraris A, Le Pimpec-Barthes F, Cholley B. Prevalence and time-course of diaphragmatic dysfunction following lung resection: A repeated ultrasonic assessment. Anaesth Crit Care Pain Med 2022; 41:101024. [PMID: 35121186 DOI: 10.1016/j.accpm.2022.101024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Ultrasound (US) allows non-invasive repeated assessments of diaphragmatic excursion (DE) and thickening fraction (DTF) at the bedside, reflecting diaphragmatic dysfunction (DD). We aimed at determining the prevalence and time-course of DD following elective thoracic surgery and the association with postoperative complications. MATERIAL AND METHODS Prospective, single-centre, observational study with consecutive patients undergoing thoracic surgery. DE/DTF were measured by two observers blinded to each other at 3 different time-points: prior to surgery, immediately after extubation and on postoperative day 3. The changes in DE/DTF of both hemi-diaphragms over time were compared according to the side (operated/non-operated) using a two-way-ANOVA. The association with postoperative complications was assessed using logistic regression. RESULTS Fifty patients, 60% males, aged 60 ± 15 years were included. Surgical procedures included lobectomy (n = 30), wedge-resection (n = 17) or pneumonectomy (n = 3). On the operated side, we observed a decrease in DE/DTF at D0 (-0.71 ± 0.12 mm, P < 0.05; -44 ± 30%, P < 0.05) and D3 (-0.82 ± 0.19 mm, P < 0.05; -39 ± 19%, P < 0.05) with respect to preoperative and non-operated side values over the study period. Persistent DD on the operated side was associated with an increased risk of lung infection (OR: 9.0, 95%CI [1.92-65.93], P = 0.001), ICU-admission (OR: 3.9, 95%CI [1.10-15.53], P = 0.04) according to univariate analysis and a prolonged length in hospital (OR: 1.3, 95%CI [1.1-1.7], P = 0.016) according to multivariate analysis. CONCLUSIONS Thoracic surgery generates DD mainly observed on the operated side, which persists at least up to postoperative D3 and is associated with an increase in hospital stay.
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Affiliation(s)
- Matthieu Daniel
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France.
| | - Elodie Lang
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Thi Mum Huynh
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Julien Martin
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Myriam Brebion
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Karim Guessous
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Diane Zlotnik
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Laura Gouzien
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Oussama Chaouch
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Paul Delval
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Arnaud Ferraris
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Françoise Le Pimpec-Barthes
- Department of Thoracic surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France; Inserm UMR_S 1140 "Innovations Thérapeutiques en Hémostase", Paris, France
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Zhu JL, Wang XT, Gong J, Sun HB, Zhao XQ, Gao W. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial. BMC Anesthesiol 2020; 20:22. [PMID: 31973700 PMCID: PMC6979058 DOI: 10.1186/s12871-020-0941-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. Methods A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine/morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded. Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores. Conclusions The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery. Trial registration Chinese Clinical Trial Registry, ChiCTR 1,800,015,141, 10 March 2018.
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Affiliation(s)
- Jing-Li Zhu
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xue-Ting Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jing Gong
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hai-Bin Sun
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiao-Qing Zhao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Gao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, China.
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Cavalcanti MGDO, Andrade LB, Santos PCPD, Lucena LRR. NON-INVASIVE PREVENTIVE VENTILATION WITH TWO PRESSURE LEVELS IN THE POSTOPERATIVE PERIOD OF ROUX-EN-Y GASTRIC BYPASS: RANDOMIZED TRIAL. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1361. [PMID: 29947695 PMCID: PMC6049999 DOI: 10.1590/0102-672020180001e1361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. AIM To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. METHODS This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. RESULTS Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. CONCLUSION It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.
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Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection. Eur Arch Otorhinolaryngol 2018; 275:1227-1234. [PMID: 29508056 DOI: 10.1007/s00405-018-4923-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Inspiratory strength after a neck dissection has not been evaluated, and diaphragm function has not been adequately evaluated. OBJECTIVE Evaluate diaphragm mobility and inspiratory strength after neck dissection. METHODS Prospective data collection of a consecutive series of adult patients submitted to neck dissection for head and neck cancer treatment, in a tertiary referral cancer center, from January to September 2014, with 30 days of follow-up. A total of 43 were studied (recruited 56; excluded 13). MAIN OUTCOME MEASURES Determine diaphragm mobility and inspiratory muscle strength after neck dissection, using diaphragm ultrasound and by measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP). RESULTS Thirty patients underwent unilateral neck dissection, and thirteen patients underwent bilateral neck dissection. Diaphragm immobility occurred in 8.9% of diaphragms at risk. For the entire cohort, inspiratory strength decreased immediately after the dissection but returned to preoperative values after 1 month. Except for those with diaphragm immobility, diaphragm mobility remained unchanged after the dissection. One month after the dissection, the diaphragm thickness decreased, indicating diaphragm atrophy. CONCLUSIONS Immediately after a neck dissection, just a few patients showed diaphragmatic immobility, and there was a transient decrease in inspiratory strength in all individuals. Such findings can increase the risk of postoperative complications in patients with previous lung disease.
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Sato M, Iida T, Kikuchi C, Sasakawa T, Kunisawa T. Comparison of caudal ropivacaine-morphine and paravertebral catheter for major upper abdominal surgery in infants. Paediatr Anaesth 2017; 27:524-530. [PMID: 28181346 DOI: 10.1111/pan.13104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The caudal epidural block is one of the most commonly used regional anesthetic techniques in children. Administration of morphine via caudal injection enables analgesia, even for upper abdominal surgery. The thoracic paravertebral block has also been successfully used to treat perioperative pain during upper abdominal procedures in pediatric patients. AIM In the current study, we compared the two regional techniques for upper abdominal surgery in infants to determine whether one of them was preferable to the other. METHODS Consecutive patients under 12 months of age who underwent upper abdominal surgery were retrospectively divided according to the chosen postoperative analgesia: Group C, caudal ropivacaine-morphine; Group P, paravertebral catheter. We analyzed the following outcomes: requirement for additional analgesics, pain scores, need for mechanical ventilation and oxygen dosage, postoperative blood pressure and heart rate, time to pass first stool, time until first full meal, and complications. RESULTS Twenty-one consecutive patients were included: 10 in Group C and 11 in Group P. Median age at surgery was 80 (47.5-270.0) and 84.5 (34.3-287.5) days, respectively. No difference was found between the two groups in requirement for additional analgesics at 24 h after surgery (median 1 in Group C vs 1 in Group P, P = 0.288, 95% CI: -2 to 1). BOPS pain scores were only lower in Group P when compared to Group C at 24 h after surgery (median 1 vs 2, P = 0.041, 95% CI: -2 to 0). None of the patients had perioperative complications. CONCLUSIONS In this small series, there was no significant difference between caudal ropivacaine-morphine and paravertebral catheter for postoperative care in infants undergoing upper abdominal surgery. Further prospective studies are needed to compare the efficacy and incidence of complications of caudal block and paravertebral catheter for postoperative analgesia.
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Affiliation(s)
- Makoto Sato
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Chika Kikuchi
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tomoki Sasakawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10-35 mm. World J Urol 2015; 33:2131-6. [PMID: 25971205 DOI: 10.1007/s00345-015-1585-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare ultra-mini PCNL (UMP) and flexible ureteroscopy (fURS) for the treatment of medium- to large-sized renal stones with a focus on patients' postsurgical cumulative analgesic consumption and treatment-related satisfaction. METHODS Twenty-five patients treated by UMP between April 2013 and October 2014 were matched to data of 25 fURS patients from an existing database. Clinical outcome parameters were recorded prospectively. Postoperative analgesic consumption was assessed using the Cumulative Analgesic Consumption Score (CACS), and satisfaction was measured with the Freiburg Index of Patient Satisfaction (FIPS) questionnaire. RESULTS Perioperative outcome parameters showed no significant differences except for mean operating times (fURS 98.52 min, UMP 130.12 min [p = 0.002]) and hospital stay (fURS 67.2 h, UMP 91.5 h [p = 0.04]). Primary stone-free rate was 96 % in fURS and 92 % in UMP. Complications Clavien grade 2 or 3 occurred in 16 % of UMP patients and in 4 % of fURS patients. Postsurgical cumulative analgesic consumption was almost identical in both groups with CACSs of 6.96 (0-15) for fURS and 6.8 (0-23) for UMP. Patients' satisfaction was high in both techniques: FIPS score in fURS 1.67 (1-3) and 1.73 (1-4) in UMP (scale 1-6). CONCLUSIONS Treatment of medium- to large-sized renal stones is safe and highly effective by both UMP and fURS. Moreover, both treatments yield comparable postsurgical analgesic requirements and high patient satisfaction scores. Patient-related factors (anatomical and stone related) and availability of technical equipment and surgical expertise appear to be the most important determining factors in treatment planning.
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Schoenthaler M, Miernik A, Offner K, Karcz WK, Hauschke D, Sevcenco S, Kuehhas FE, Bach C, Buchholz N, Wilhelm K. The cumulative analgesic consumption score (CACS): evaluation of a new score to describe postsurgical analgesic consumption as a surrogate parameter for postoperative pain and invasiveness of surgical procedures. Int Braz J Urol 2015; 40:330-6. [PMID: 25010299 DOI: 10.1590/s1677-5538.ibju.2014.03.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/24/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate and evaluate the applicability of a new score to describe postsurgical analgesic consumption in urological and surgical patients across different categories of pain medications and the invasiveness of medical interventions. MATERIALS AND METHODS The cumulative analgesic consumption score (CACS) was determined for two cohorts of patients split into three groups with surgeries involving clinically distinct levels of invasiveness (n = 2 x 60). Nonparametric statistical analyses were performed to determine differences between the CACS among the different groups and to assess the correlation between CACS and numeric rating scale (NRS) values for pain intensity. RESULTS The score was determined for postoperative days 1 and 2 and revealed median scores of 0 (0-11), 3 (0-22) and 10 (6-17) for UA (urological patients from group A), UB (group B) and UC (group C), respectively, and 4 (0-20), 8 (0-38) and 17 (7-68) for SA (surgical patients from group A, SB (group B) and SC (group C), respectively. CACS enabled reliable differentiation between groups involving different levels of invasiveness (p < 0.001). CACS and peak NRS values showed variable degrees of correlation, as expressed by levels of significance ranging from p < 0.001 to p = 0.34 (NS). CONCLUSIONS The CACS is a valid and easily applicable tool to describe postsurgical analgesic consumption in urological and surgical patients. It can be used as a surrogate parameter to assess postsurgical pain and the invasiveness of surgical procedures. These aspects may be measured to compare surgical procedures, in both clinical trials and clinical practice settings.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- 1Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Offner
- Department of Anesthesiology, , University Medical Center Freiburg, Freiburg, Germany
| | - Wojciech Konrad Karcz
- Department of General and Visceral Surgery, , University Medical Center Freiburg, Freiburg, Germany
| | - Dieter Hauschke
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
| | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Bach
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Noor Buchholz
- Department of Urology, The Royal London Hospital, Bartshealth NHS Trust, London, United Kingdom
| | - Konrad Wilhelm
- Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
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Influence of different body positions in vital capacity in patients on postoperative upper abdominal. Braz J Anesthesiol 2015; 65:217-21. [PMID: 25925035 DOI: 10.1016/j.bjane.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022] Open
Abstract
RATIONALE The changes in body position can cause changes in lung function, and it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2 ± 11.2 years, BMI 20.2 ± 1.0 kg/m(2). The position on orthostasis showed higher values of vital capacity regarding standing (mean change: 0.15 ± 0.03 L; p=0.001), the supine to 45 (average difference: 0.32 ± 0.04 L; p = 0.001) and 0° (0.50 ± 0.05 L; p = 0.001). There was a positive trend between the values of forced vital capacity supine to upright posture (1.68 ± 0.47; 1.86 ± 0.48; 2.02 ± 0.48 and 2.18 ± 0.52 L; respectively). CONCLUSION Body position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.
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Brigatto P, Carbinatto JC, Costa CM, Montebelo MIL, Rasera-Júnior I, Pazzianotto-Forti EM. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial. Braz J Phys Ther 2015; 18:553-62. [PMID: 25590448 PMCID: PMC4311600 DOI: 10.1590/bjpt-rbf.2014.0054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/18/2014] [Indexed: 12/04/2022] Open
Abstract
Objective: To evaluate whether the application of bilevel positive airway pressure in the
postoperative period of bariatric surgery might be more effective in restoring
lung volume and capacity and thoracic mobility than the separate application of
expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery
and met the predefined inclusion criteria were evaluated. The pulmonary function
and thoracic mobility were preoperatively assessed by spirometry and cirtometry
and reevaluated on the 1st postoperative day. After preoperative
evaluation, the subjects were randomized and allocated into groups: EPAP Group
(n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding
intervention: positive expiratory pressure (EPAP), inspiratory positive pressure
breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6
sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period
and on the 1st postoperative day, in addition to conventional physical
therapy. Results: There was a significant postoperative reduction in spirometric variables
(p<0.05), regardless of the technique used, with no significant difference
among the techniques (p>0.05). Thoracic mobility was preserved only in group
BIPAP (p>0.05), but no significant difference was found in the comparison among
groups (p>0.05). Conclusion: The application of positive pressure does not seem to be effective in restoring
lung function after bariatric surgery, but the use of bilevel positive pressure
can preserve thoracic mobility, although this technique was not superior to the
other techniques.
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Affiliation(s)
- Patrícia Brigatto
- Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
| | - Jéssica C Carbinatto
- Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
| | - Carolina M Costa
- Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
| | | | | | - Eli M Pazzianotto-Forti
- Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
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Martinez BP, Silva JR, Silva VS, Neto MG, Forgiarini Júnior LA. [Influence of different body positions in vital capacity in patients on postoperative upper abdominal]. Rev Bras Anestesiol 2014; 65:217-21. [PMID: 25990497 DOI: 10.1016/j.bjan.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0 kg/m(2). The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15±0.03 liters; p=0.001), the supine to 45 (average difference: 0.32±0.04 liters; p=0.001) and 0° (0.50±0.05 liters; p=0.001). There was a positive trend between the values of FVC supine to upright posture (1.68±0.47; 1.86±0.48; 2.02±0.48 and 2.18±0.52 liters; respectively). CONCLUSION Body position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.
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Affiliation(s)
- Bruno Prata Martinez
- Hospital Aliança, Salvador, BA, Brasil; Escola Baiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brasil; Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil
| | | | - Vanessa Salgado Silva
- Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | | | - Luiz Alberto Forgiarini Júnior
- Centro Universitário Metodista (IPA), Programa de Pós-graduação em Reabilitação e Inclusão, e, Biociências e Reabilitação, Porto Alegre, RS, Brasil; Laboratório de Vias Aéreas e Pulmão do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
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Beaussier M, Genty T, Lescot T, Aissou M. Influence of pain on postoperative ventilatory disturbances. Management and expected benefits. ACTA ACUST UNITED AC 2014; 33:484-6. [DOI: 10.1016/j.annfar.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cleva RD, Assumpção MSD, Sasaya F, Chaves NZ, Santo MA, Fló C, Lunardi AC, Jacob Filho W. Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery. Clinics (Sao Paulo) 2014; 69:483-6. [PMID: 25029580 PMCID: PMC4081878 DOI: 10.6061/clinics/2014(07)07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/04/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). METHODS We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. RESULTS The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. CONCLUSIONS Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.
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Affiliation(s)
- Roberto de Cleva
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marianna Siqueira de Assumpção
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flavia Sasaya
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Natalia Zuniaga Chaves
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Fló
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana C Lunardi
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Geriatric Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Souza Possa S, Braga Amador C, Meira Costa A, Takahama Sakamoto E, Seiko Kondo C, Maida Vasconcellos A, Moran de Brito C, Pereira Yamaguti W. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:69-77. [DOI: 10.1016/j.rppneu.2013.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/13/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022] Open
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Karakurt Z, Fanfulla F, Ceriana P, Carlucci A, Grassi M, Colombo R, Karakurt S, Nava S. Physiologic determinants of prolonged mechanical ventilation in patients after major surgery. J Crit Care 2012; 27:221.e9-16. [DOI: 10.1016/j.jcrc.2011.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022]
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Influence of visceral obesity for postoperative pulmonary complications after pancreaticoduodenectomy. J Gastrointest Surg 2011; 15:1401-10. [PMID: 21567293 DOI: 10.1007/s11605-011-1436-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/26/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND We conduct this study to determine whether postoperative complications, including postoperative pulmonary complications (PPCs), are associated with BMI and visceral fat area (VFA) after pancreaticoduodenectomy. METHODS A total of 317 patients undergoing pancreaticoduodenectomy were enrolled. VFA was measured using a cross-sectional computed tomography (CT) scan at the level of the umbilicus by FatScan software version 3.0 (N2 systems Inc., Osaka, Japan). Clinicopathological variables, intraoperative outcomes, and postoperative courses were analyzed. RESULTS Of all patients, 130 (41.0%) had postoperative complications and PPCs occurred in 14 patients (4.4%). VFA were significantly higher in patients who developed postoperative pancreatic fistula (POPF), PPCs, and mortality than in those patients who did not (P = .0282, P = .0058, and P = .0173, respectively). Multivariate analysis demonstrated that high BMI and high VFA were not independent predictive risk factors for POPF grade B/C and mortality; only high VFA was an independent risk factor influencing PPCs (P = .0390, odds ratio 4.246, 95% confidence interval 1.076-16.759). CONCLUSIONS Visceral obesity was the independent risk factor for the incidence of PPCs after pancreaticoduodenectomy. Preoperative VFA measurement using CT scan is a useful tool for the prediction of the development of PPCs compared to BMI calculation.
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Srikandarajah S, Gilron I. Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: A fundamental distinction requiring standardized measurement. Pain 2011; 152:1734-1739. [DOI: 10.1016/j.pain.2011.02.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/21/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Lee BC, Kyoung KH, Kim YH, Hong SK. Non-invasive ventilation for surgical patients with acute respiratory failure. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:390-6. [PMID: 22066065 PMCID: PMC3204685 DOI: 10.4174/jkss.2011.80.6.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 02/22/2011] [Indexed: 12/02/2022]
Abstract
Purpose Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. Methods We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory failure. The patients who have got respiratory care for secondary reason such as sepsis and encephalopathy were excluded from this study. Results Of the 74 patients who were treated with mechanical ventilation, 15 underwent NIV and 59 underwent invasive ventilation. The causes of acute respiratory failure in the NIV group were atelectasis in 5 patients, pneumonia in 5, acute lung injury in 4, and pulmonary edema in 1, this group included 3 patients with acute respiratory failure after extubation. Overall success rate of NIV was 66.7%. Conclusion NIV may be an alternative to conventional ventilation in surgical patients with acute respiratory failure. Use of NIV may avoid re-intubation in patients who develop respiratory failure after intubation.
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Affiliation(s)
- Byoung Chul Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, Cissé M, Lefrant JY, Jaber S. The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales. Pain 2010; 151:711-721. [DOI: 10.1016/j.pain.2010.08.039] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 08/17/2010] [Accepted: 08/23/2010] [Indexed: 01/20/2023]
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Cheifetz O, Lucy SD, Overend TJ, Crowe J. The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiother Can 2010; 62:242-53. [PMID: 21629603 DOI: 10.3138/physio.62.3.242] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. METHODS Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. RESULTS Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group. CONCLUSION Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
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Affiliation(s)
- Oren Cheifetz
- Oren Cheifetz, PT, MSc: Clinical Specialist-Physiotherapy, Hamilton Health Sciences, Hamilton, Ontario
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Jaber S, Michelet P, Chanques G. Role of non-invasive ventilation (NIV) in the perioperative period. Best Pract Res Clin Anaesthesiol 2010; 24:253-65. [DOI: 10.1016/j.bpa.2010.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Parietal Analgesia Decreases Postoperative Diaphragm Dysfunction Induced by Abdominal Surgery. Reg Anesth Pain Med 2009; 34:393-7. [PMID: 19920413 DOI: 10.1097/aap.0b013e3181ae11c9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barbalho-Moulim MC, Miguel GPS, Forti EMP, Costa D. Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000200013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês) e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por videolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m², submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias). Foram divididas em dois grupos, GI - grupo inspirômetro (n=13) e GE, grupo EPAP (n=15). A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós-operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório.
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Forgiarini Junior LA, Carvalho ATD, Ferreira TDS, Monteiro MB, Bosco AD, Gonçalves MP, Dias AS. Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal. J Bras Pneumol 2009. [DOI: 10.1590/s1806-37132009000500011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cirurgia abdominal causa uma série de complicações pulmonares após o processo cirúrgico. Assim, faz-se necessário um tratamento precoce adequado objetivando minimizar as complicações no período pós-operatório. Objetivamos avaliar o efeito do atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal. Este foi um ensaio clínico randomizado, no qual um grupo recebeu atendimento fisioterapêutico na sala de recuperação e, posteriormente, nas enfermarias, e outro grupo o recebeu somente nas enfermarias. Concluímos que a fisioterapia realizada no pós-operatório imediato reduziu a perda da função pulmonar, a perda da força muscular ventilatória e o tempo de internação na sala de recuperação.
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Barbalho-Moulim MC, Miguel GPS, Forti EMP, César MDC, Azevedo JLMC, Costa D. Silicone-ring Roux-en-Y gastric bypass in the treatment of obesity: effects of laparoscopic versus laparotomic surgery on respiration. Obes Surg 2009; 21:194-9. [PMID: 19301079 DOI: 10.1007/s11695-009-9823-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND The objective of this study was to compare the effects of silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy versus that accomplished by laparotomy on pulmonary function. METHODS A total of 26 women (body mass index (BMI) 35-49 kg/m(2)) were studied candidates for silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy (LG; n = 13) and laparotomy (or open surgery (OG); n = 13). Smokers, patients having lung disease, and those unable to carry out the tests properly were excluded. The physical therapy was standardized for both the groups. Respiratory evaluation was carried out during the preoperative period and on the second postoperative day by using spirometry and other tests that evaluated respiratory muscle strength and diaphragmatic mobility. Pain was evaluated by the visual analog scale on the second postoperative day. The statistical analysis was carried out with parametric or nonparametric tests, depending on the distribution of variables, considering p < 0.05 as statistically significant. RESULTS Patients were similar with respect to age, BMI, and waist-to-hip ratio. A decrease in all variables was observed for both the groups in the postoperative period, although this decrease was less pronounced in the LG group. Pain intensity was also lower in the LG group. The length of hospital stay was 2 days, and there were no pulmonary complications. CONCLUSION As there were no differences in the incidence of pulmonary complications and the length of hospital stay between the groups, the results showed that silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy caused less pain and impairment of pulmonary function in the postoperative period.
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Jaber S, Chanques G, Jung B. Postoperative Non-invasive Ventilation. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haeffener MP, Ferreira GM, Barreto SSM, Arena R, Dall'Ago P. Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. Am Heart J 2008; 156:900.e1-900.e8. [PMID: 19061704 DOI: 10.1016/j.ahj.2008.08.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 08/03/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of the incentive spirometry (IS) with expiratory positive airway pressure (EPAP) to prevent postoperative pulmonary complications (PPC) after coronary artery bypass graft (CABG) is not well established. This study sought to determine the effects of IS+EPAP after CABG. METHODS Thirty-four patients undergoing CABG were randomly assigned to a control group or IS+EPAP group. Maximal respiratory pressures, pulmonary function test, 6-minute walk test and chest x-ray were performed at baseline as well as 1 week and 1 month after CABG. RESULTS Maximal inspiratory pressure was significantly higher in the IS+EPAP group compared to controls at both 1 week and 1 month (P<.001). Maximal expiratory pressure was significantly higher at 1 month compared to 1 week in IS+EPAP group (P<.01). At 1 month, forced vital capacity and forced expiratory volume in 1 second was significantly higher in IS+EPAP compared to controls (P<.05). Inspiratory capacity was higher at 1 month in IS+EPAP group compared to controls (P<.05). The distance walked in 6-minute walk test was higher at 1 month in IS+EPAP group (P<.001) compared to controls. Lastly, radiological injury score at 1 week was lower in IS+EPAP compared to controls (P<.004). CONCLUSIONS In patients undergoing CABG, IS+EPAP results in improved pulmonary function and 6-minute walk distance as well as a reduction in PPC.
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Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function. J Clin Anesth 2008; 20:200-5. [PMID: 18502364 DOI: 10.1016/j.jclinane.2007.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 10/10/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To determine how effort pain interacts with changing pulmonary function after upper abdominal incisions. DESIGN Prospective, case-controlled study. SETTING Academic teaching hospital. PATIENTS 34 ASA physical status I, II, and III patients recovering from elective, major incisional, upper abdominal surgery. MEASUREMENTS Manometry (maximal inspiratory and expiratory pressure) and spirometry (forced vital capacity, forced expiratory volume during the first second, peak expiratory flow) for three postoperative days. Pain scores (Visual Analog Pain Scale; VAS) at rest and after the manometric or spirometric efforts. MAIN RESULTS Effort pain during either manometry or spirometry was greater than pain at rest on the first postoperative day. Maximal respiratory pressure concomitantly recovered with pain during daily efforts (slopes: -0.429 and -0.278% max/mm VAS; P < 0.05). Spirometric measurements showed minimal improvement. CONCLUSION The direct relationship between resolution of pain with effort and direct measures of respiratory muscle effort using manometry, but not those obtained less directly by spirometry, suggests that assessing interactions between pain and effort requires a direct, quantifiable measure of effort.
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Virmani R, Ghai A, Singh DK. A study to compare continuous epidural infusion and intermittent bolus of bupivacaine for postoperative analgesia following renal surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Interactions Between Pulmonary Performance and Movement-Evoked Pain in the Immediate Postsurgical Period. Reg Anesth Pain Med 2008. [DOI: 10.1097/00115550-200807000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Association of the shrinking lung syndrome in systemic lupus erythematosus with pleurisy: a systematic review. Semin Arthritis Rheum 2008; 39:30-7. [PMID: 18585760 DOI: 10.1016/j.semarthrit.2008.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 04/01/2008] [Accepted: 04/28/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To report 2 patients with systemic lupus erythematosus and typical shrinking lung syndrome (SLS) in which pleuritic chest pain was the predominant symptom. In addition, to record the prevalence of pleuritic chest pain in all reported cases of patients with SLS and diaphragmatic dysfunction. METHODS We conducted a comprehensive search of the English literature to record the association of pleurisy and SLS in all reported cases using the MEDLINE database from 1965 to present. RESULTS Of the 77 patients with SLS reported in the literature, 50 (65%) patients had pleuritic chest pain at the time of evaluation. Treatment with anti-inflammatory agents improved symptoms in the majority of cases. CONCLUSIONS Pleuritic inflammation and pain may have an important role in the pathogenesis of SLS. A possible mechanism linking pleural inflammation and diaphragm dysfunction may be via a reflex inhibition of diaphragmatic activation.
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Gilron I, Orr E, Tu D, O'Neill JP, Zamora JE, Bell AC. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain 2005; 113:191-200. [PMID: 15621380 DOI: 10.1016/j.pain.2004.10.008] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 10/08/2004] [Accepted: 10/14/2004] [Indexed: 12/27/2022]
Abstract
Current treatments for post-injury movement-evoked pain are inadequate. Non-opioids may complement opioids, which preferentially reduce spontaneous pain, but most have incomplete efficacy as single agents. This trial evaluates efficacy of a gabapentin-rofecoxib combination following hysterectomy. In addition to IV-PCA morphine, 110 patients received either placebo, gabapentin (1800 mg/day), rofecoxib (50 mg/day) or a gabapentin-rofecoxib combination (1800/50 mg/day) starting 1 h pre-operatively for 72 h. Outcomes included pain at rest, evoked by sitting, peak expiration and cough, morphine consumption and peak expiratory flow (PEF). For placebo, gabapentin, rofecoxib and combination, 24 h pain (100 mm VAS) was: at rest-23.6 (P<0.05 vs. all treatments), 13.8, 14.4 and 12.1; during cough-50.7 (P<0.05 vs. all treatments), 41.5, 44.8 and 30.8; 48 h morphine consumption (mg) was: 130.4 (P<0.05 vs. all treatments), 81.7, 75.6 and 57.2 (P<0.05 vs. gabapentin and rofecoxib) and 48 h PEF (% baseline) was: 63.9 (P<0.05 vs. all treatments), 77.2, 76.7 and 87.5 (P<0.05 vs. gabapentin and rofecoxib). Adverse effects were similar in all groups except sedation which was more frequent with gabapentin. Combination and rofecoxib reduced pain interference with movement, mood and sleep (P<0.05) and combination was superior to gabapentin for all these three (P<0.05). These data suggest that a gabapentin-rofecoxib combination is superior to either single agent for postoperative pain. Other benefits include opioid sparing, reduced interference with movement, mood and sleep and increased PEF suggesting accelerated pulmonary recovery. Future research should identify optimal dose-ratios for this and other analgesic combinations.
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Affiliation(s)
- Ian Gilron
- Department of Anesthesiology, Queen's University, 76 Stuart Street, Kingston, Ont., Canada ON K7L 2V7.
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Abstract
The act of breathing depends on coordinated activity of the respiratory muscles to generate subatmospheric pressure. This action is compromised by disease states affecting anatomical sites ranging from the cerebral cortex to the alveolar sac. Weakness of the respiratory muscles can dominate the clinical manifestations in the later stages of several primary neurologic and neuromuscular disorders in a manner unique to each disease state. Structural abnormalities of the thoracic cage, such as scoliosis or flail chest, interfere with the action of the respiratory muscles-again in a manner unique to each disease state. The hyperinflation that accompanies diseases of the airways interferes with the ability of the respiratory muscles to generate subatmospheric pressure and it increases the load on the respiratory muscles. Impaired respiratory muscle function is the most severe consequence of several newly described syndromes affecting critically ill patients. Research on the respiratory muscles embraces techniques of molecular biology, integrative physiology, and controlled clinical trials. A detailed understanding of disease states affecting the respiratory muscles is necessary for every physician who practices pulmonary medicine or critical care medicine.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Edward Hines, Jr. VA Hospital, 111 N. 5th Avenue and Roosevelt Road, Hines, IL 60141, USA.
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Gilron I, Tod D, Goldstein DH, Parlow JL, Orr E. The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy. Anesth Analg 2002; 95:1702-7, table of contents. [PMID: 12456443 DOI: 10.1097/00000539-200212000-00043] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED The pathogenesis of postoperative lung dysfunction implies a role for movement-evoked pain (e.g., splinting/hypoventilation because of pain avoidance). However, interactions between evoked pain and respiratory physiology are poorly understood. Thus, we examined the relationship between evoked versus spontaneous pain and one index of pulmonary function. In 25 patients having undergone a hysterectomy, visual analog scale ratings (100 mm) for spontaneous pain (REST) and pain during sitting (SIT), forced expiration (BLOW), and coughing (COUGH) were measured together with peak expiratory flow (PEF) at eight time points during postoperative Days 1 and 2. Secondary outcome measures included oxygen saturation and oxygen requirements. Pain was significantly correlated with PEF for COUGH, SIT, BLOW, and REST at eight, seven, four, and two of the eight studied time points, respectively. Mean visual analog scale scores [SE] for COUGH (26.1 mm [1.7]) and SIT (21.5 mm [1.5]) were greater (P < 0.05) than REST (10.5 mm [0.8]), and COUGH was greater (P < 0.05) than BLOW (16.8 mm [1.3]). All pain measures diminished (P < 0.05), and PEF reductions improved (P < 0.05) across the study period. We hypothesize that the consistent negative correlation of COUGH-evoked pain with PEF is, in part, caused by avoidance of coughing, which ultimately limits deep inspiration, lung reexpansion, and clearance of secretions. IMPLICATIONS Movement-evoked pain may be an important contributor to postoperative complications, but its mechanisms are poorly understood. This study provides the first evidence that postoperative evoked pain correlates with lung function and highlights the need for future research on mechanisms and implications of this phenomenon.
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Affiliation(s)
- Ian Gilron
- Department of Anesthesiology and Pharmacology & Toxicology, Queen's University, Kingston, Ontario, Canada.
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Tobin MJ. Sleep-disordered breathing, control of breathing, respiratory muscles, pulmonary function testing, nitric oxide, and bronchoscopy in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1362-75. [PMID: 11704580 DOI: 10.1164/ajrccm.164.8.2108124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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Abstract
Nosocomial pneumonia (NP) is well documented as the second most common nosocomial infection. It is now more common in surgical patients than surgical-site or wound infection. Healthcare implications of NP include not only increased patient morbidity and mortality, but also increased use of healthcare resources. The advanced practice nurse plays an integral role in the prevention and minimization of NP across healthcare settings. This article focuses on postoperative NP after abdominal, cardiac, or thoracic surgery in the non-mechanically ventilated patient and discusses the diagnostic assessment, risk factors, and potential nurse-sensitive interventions to prevent or minimize this complication. Ideas for potential nursing research related to these risk factors are described.
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Affiliation(s)
- J A Brooks
- Indiana University Medical Center, Pulmonary, Critical Care and Occupational Medicine, 550 N. University Boulevard, UH5450, Indianapolis, IN 46202-5250, USA.
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