There are the surgeries such as cardiac surgery, which results in the respiratory complications in the patients. The most frequent complication encountered by the patient is atelectasis. The other problems may include post-operative pain, nervous dysfunction and effect of the drugs administered during surgery such as anesthetics or sedatives.
Further the sternotomy causes the change in the mechanical structure of the thoracic wall adding up more to the complication.
The medical science is continuously working on the prevention of such incidents while treating the patient for these disorders. There are certain measures advised by the physicians to provide better care for such patients. These measures may include chest exercises and the use of incentive spirometry. The other typical methods employed by the medical professionals include continuous positive airway pressure and bi-level positive airway pressure. The complications associated persist from 3-4 days to 20-25 days.
During the cardiac and abdominal surgery, atelectasis may occur very often. The risk of post-operative atelectasis may be more in patients who are obese and do smoking. The patients with respiratory disease such as asthma and lung infection should be provided with extra care. The post-operative atelectasis may occur within 48 hours of surgery. This can be prevented by stopping the smoking 6 to 8 weeks prior to surgery and the patient is advised with certain breathing exercises.
How Can Post-operative Atelectasis Be Prevented?
Generally, atelectasis is most prominent complications of the surgeries of the thoracic and the abdominal cavity. Various researchers have written on the preventive measures to reduce the chances of atelectasis. In the current scenario, the surgeons are likely to take the preventive measures than to treat the atelectasis due to surgery. Following are measures which can be practices for preventing post-operative atelectasis:
- Lifestyle Modifications: The patient has to do certain lifestyle modifications to reduce the risk of atelectasis during surgery. The patient, if smokes should stop smoking at least eight weeks before the surgery. Further, moving around the body and stepping from the bed frequently after the surgery may also help in reducing atelectasis. Further, the patient should also follow the advice of the physician regarding the exercise including deep breathing. The incentive spirometry is also used as an aid in avoiding atelectasis.
- Care: Extra care should be taken of the patients suffering from the inflammation of the respiratory tract and the patients with risk of abdominal distension.
- Drugs: Large doses of anesthetics and sedatives should be avoided during and after the surgery.
- Mechanical Support: To avoid the breathing pause, carbon dioxide and oxygen should be administered to the patients. Mechanical support system may be used to support breathing.
- Surgery Time: Operating time should be as little as possible and the pressure on the chest should be avoided.
- Dilatation: Dilatation of the stomach should be done only when required.
Occurring in about 90% of all the surgical complications, there are many factors, which contributes to the respiratory complication including atelectasis i.e. it is a multifactorial phenomenon. Apart from the causes mentioned below, the patients having obesity, smoking, longer duration of surgery and history of respiratory disease are at higher risk when compared with their counterpart. Following are the causes for atelectasis:
- Effect Of Anesthesia: The effect of anesthesia used during the surgery may cause atelectasis. During anesthesia, the secretion which are secreted in the respiratory tract are not been pushed by the ciliary movement. Thus, these secretion, which were more of the watery nature becomes thick and stiff and forms a plug in respiratory system.
- Effect Of Sedatives: The sedatives which are administered during the surgery may be the reason for atelectasis. These drugs may depress the respiratory center and diminishes pulmonary ventilation.
- Nervous Dysfunction: The respiration is the phenomenon which is controlled by the nervous system. Any dysfunction in the nervous system during the surgery may cause atelectasis.
- Sternotomy: Sternotomy is the process of cutting of the sternum when the surgery is done thoracic region such as of the heart.
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