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

Marcio Aparecido Oliveira,Renato Almeida,José Roberto Jardim,Milena Carlos Vidotto,Evandro Fornias Sperandio,Mariana Rodrigues Gazzotti,Ilka Lopes Santoro,Oliver Augusto Nascimento

doi:10.1590/1516-3180.2014.00252601

Marcio Aparecido Oliveira, Renato Almeida + Show 6 more

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https://doi.org/10.1590/1516-3180.2014.00252601

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Abstract

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Highlights

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery.[1,2,3,4] The most frequently occurring changes are reduction in lung volume, changes to breathing patterns, altered gas exchange with reduction in partial arterial oxygen pressure (PaO2), increase in partial arterial carbon pressure (PaCO2) in the arterial blood and impairment of mucociliary transport.[5,6,7] Recent studies have demonstrated that similar changes occur in patients who undergo craniotomy, which is considered to be a peripheral surgical procedure
The exclusion criteria were any presence of preoperative respiratory symptoms or obstructive or restrictive lung disease based on self-reports or clinical and radiological analysis; inability to perform spirometric or manometric procedures; postoperative respiratory support lasting more than 24 hours; pain greater than two points on the visual analog scale (VAS) during evaluations after the administration of analgesic medication; and death or brain death during the postoperative period
The preoperative evaluation consisted of a clinical examination; investigation of past history of lung disease and smoking status; assessment of any presence of pain; and measurement of ventilation, vital capacity (VC) and respiratory muscle strength

Summary

Introduction

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery.[1,2,3,4] The most frequently occurring changes are reduction in lung volume, changes to breathing patterns, altered gas exchange with reduction in partial arterial oxygen pressure (PaO2), increase in partial arterial carbon pressure (PaCO2) in the arterial blood and impairment of mucociliary transport.[5,6,7] Recent studies have demonstrated that similar changes occur in patients who undergo craniotomy, which is considered to be a peripheral surgical procedure These patients experience reduction in lung volume, changes to respiratory patterns (from predominantly diaphragmatic to intercostal), hypoxemia and reduction in mucociliary transport.[8,9] Other factors can contribute to the reduction in pulmonary volumes, such as general anesthesia, pain, immobility in bed and supine position.[5,6] Up to 95% of patients with normal lungs who undergo general anesthesia may present atelectasis, which persists for more than 24 hours in 50% of the cases.

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