Postoperative Respiratory Function Research Articles

Double-Blind Controlled Trial of Indomethacin as an Adjunct to Narcotic Analgesia After Major Abdominal Surgery

A prospective randomised trial was undertaken to assess the efficacy of indomethacin as an analgesic after abdominal surgery. 44 patients received indomethacin suppositories (100 mg every 8 h for three days postoperatively) and 46 patients received placebo suppositories (every 8 h for the same period), in addition to intramuscular morphine (0.15 mg/kg every 4 h as required). Postoperative subjective pain assessments, analgesic requirements, and respiratory function were recorded. Patients receiving indomethacin required significantly fewer doses of morphine than those receiving placebo and has less pain on each of the first four postoperative days. The duration of postoperative morphine requirement was shorter for the indomethacin than for the placebo group. pCO2 on the first postoperative day was lower in the indomethacin group than the placebo group (4.82 +/- 0.08 vs 5.18 +/- 0.08 kPa). The administration of indomethacin in addition to morphine after major abdominal surgery provides better pain control than that provided by intramuscular morphine alone.

DOUBLE-BLIND CONTROLLED TRIAL OF INDOMETHACIN AS AN ADJUNCT TO NARCOTIC ANALGESIA AFTER MAJOR ABDOMINAL SURGERY

A prospective randomised trial was undertaken to assess the efficacy of indomethacin as an analgesic after abdominal surgery. 44 patients received indomethacin suppositories (100 mg every 8 h for three days postoperatively) and 46 patients received placebo suppositories (every 8 h for the same period), in addition to intramuscular morphine (0·15 mg/kg every 4 h as required). Postoperative subjective pain assessments, analgesic requirements, and respiratory function were recorded. Patients receiving indomethacin required significantly fewer doses of morphine than those receiving placebo and had less pain on each of the first four postoperative days. The duration of postoperative morphine requirement was shorter for the indomethacin than for the placebo group. pCO 2 on the first postoperative day was lower in the indomethacin group than the placebo group (4·82±0·08 vs 5·18±0·08 kPa). The administration of indomethacin in addition to morphine after major abdominal surgery provides better pain control than that provided by intramuscular morphine alone.

Comparison of effect of narcotic and epidural analgesia on postoperative respiratory function

A prospective, randomized comparison was made of the value of meperidine versus epidural analgesia when used for the relief of pain after cholecystectomy in twenty patients without cardiopulmonary disease. Respiratory function was assessed the day before surgery and at 3 to 4 hours and 24 hours after operation by the bedside measurement of expiratory peak flow, vital capacity, and arterial blood gases. The two groups of patients were comparable as to age, height, weight, smoking habits, preoperative peak flow, vital capacity, and duration of operation. The arterial oxygen tension and oxygen saturation were significantly greater and carbon dioxide tension lower in the epidural analgesia group 24 hours after operation. At this time peak flow rates and vital capacity were not different. However, at 3 to 4 hours postoperatively, vital capacity was significantly greater in the epidural anesthesia group. This might account for the differences in arterial blood gases the following day. These findings suggest that epidural analgesia is valuable in the early postoperative period after upper abdominal surgery.

Diaphragmatic Incisions Guided by Nerve Stimulator:A Respiratory Study

Thirty-four patients with hiatus hernia, divided into two groups, were operated upon by the transthoracic and transdiaphragmatic approach. In half of the patients (group I), the diaphragmatic incisions were made without the guidance of the nerve stimulator. In the other half (group II), the line of diaphragmatic incisions was guided by the nerve stimulator in order to avoid injury to the phrenic nerve. The pre- and postoperative respiratory function, arterial blood gas tensions, and diaphragmatic functional tests were statistically analysed in both groups. In group I, significant reductions in regional ventilation, perfusion and volume of the left lung, particularly the left basal field, were associated with a high incidence of diaphragmatic paralysis (10/17). Application of the nerve stimulator in group II resulted in significant improvement in the regional lung function after surgery and the diaphragmatic paralysis could be almost avoided (1/17). No statistical differences in the spirometric values coul...

Surgical Treatment of Midline Fixation of the Bilateral Vocal Cords and its Functional Results

Midline fixation of the bilateral vocal cords occurs on rare occasions. This condition has been described as bilateral abductor or posticus paralysis. However, the term of midline fixation or immobilization in median position is more adequate. During the past 17 years, 32 cases having this condition were seen in our clinic. Surgery for this condition and its functional results were discussed. To relieve dyspnea, Woodman's operation and the widening of anterior glottis operation were performed. On performing laryngoplastic surgery, we have to succeed on the first attempt, using a meticu lous technique. Important points are not to fracture the thyroid or arytenoid cartilage and not to damage the laryngeal mucosa. Postoperatively, the patients' voice remained rather in intelligible condition. Postoperative respiratory function tests showed that improvement of lung volumes exceeded that of ventilation tests with a time factor. There were some discrepancies between the laryngoscopic findings and the results of postoperative respiratory function tests. Midline fixation of the bilateral vocal cords occurs on rare occasions. This condition has been described as bilateral abductor or posticus paralysis. However, the term of midline fixation or immobilization in median position is more adequate. During the past 17 years, 32 cases having this condition were seen in our clinic. Surgery for this condition and its functional results were discussed. To relieve dyspnea, Woodman's operation and the widening of anterior glottis operation were performed. On performing laryngoplastic surgery, we have to succeed on the first attempt, using a meticu lous technique. Important points are not to fracture the thyroid or arytenoid cartilage and not to damage the laryngeal mucosa. Postoperatively, the patients' voice remained rather in intelligible condition. Postoperative respiratory function tests showed that improvement of lung volumes exceeded that of ventilation tests with a time factor. There were some discrepancies between the laryngoscopic findings and the results of postoperative respiratory function tests.