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A comparative study between preoperative and postoperative pulmonary functions and diaphragmatic movements in
Girija P Rath1, Parmod K Bithal, Randeep Guleria
1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Craniovertebral junction anomalies cause significant respiratory dysfunction, with reduced pulmonary function persisting post-surgery. Early postoperative assessments show no improvement in lung function for these patients.
Area of Science:
- Neurology
- Pulmonology
- Medical Engineering
Background:
- Craniovertebral junction (CVJ) anomalies can lead to brainstem compression, affecting respiratory centers and respiratory muscle strength.
- Patients with CVJ anomalies often experience respiratory dysfunctions.
Purpose of the Study:
- To assess pulmonary functions, mouth pressures, and diaphragmatic movements in patients with CVJ anomalies.
- To compare these parameters with predictive values and evaluate postoperative changes.
Main Methods:
- Pulmonary function tests (FVC, FEV1, FEF25%-75%, FEV1%), maximum inspiratory and expiratory pressures, and diaphragmatic movements were measured in 30 CVJ anomaly patients.
- Parameters were assessed preoperatively and in the early postoperative period.
Main Results:
- Preoperative pulmonary functions (FVC, FEV1, FEF25%-75%) were significantly lower than predicted values (P<0.001).
- A restrictive pattern of lung disease was observed.
- Postoperative pulmonary functions showed a significant reduction (P<0.05), with no improvement in the early postoperative period. Mouth pressures and diaphragmatic movements remained comparable to preoperative values.
Conclusions:
- Patients with CVJ anomalies exhibit significant preoperative pulmonary dysfunction characterized by a restrictive lung disease pattern.
- Early postoperative pulmonary function does not improve and may even worsen, indicating a need for long-term follow-up to assess recovery trajectories.
Abstract:
Respiratory dysfunctions in patients with craniovertebral junction (CVJ) anomalies may occur due to compression of brainstem affecting the respiratory centers, and weakening of the muscles of respiration. We assessed pulmonary functions [forced vital capacity (FVC), forced expiratory volume in first second (FEV1), maximum mid-expiratory flow rate (FEF25%-75%), FEV1%], mouth pressures (maximum inspiratory pressure, maximum expiratory pressure), and diaphragmatic movements in 30 patients of CVJ anomalies and compared them with their mean predictive values. These parameters were also assessed in the postoperative period. It was found that the mean values of FVC, FEV1, and FEF25%-75% were significantly lower (P<0.001) than their mean predictive values (2.4+/-0.8 L, 2.0+/-0.7 L, 2.5+/-0.9 L vs. 3.7+/-0.9 L, 3.2+/-0.7 L, and 3.4+/-0.7 L, respectively). In the postoperative period there was significant reduction (P<0.05) in all these parameters (2.2+/-0.8 L, 1.7+/-0.7 L, and 2.1+/-0.8 L, respectively). The postoperative FEV1% was 78.8% compared with the preoperative value of 85.7%. A restrictive pattern of lung disease was observed which persisted in the postoperative period. The postoperative maximum inspiratory pressure and maximum expiratory pressure were comparable to their preoperative values (47.9+/-19.6 and 47.0+/-16.7 cmH2O vs. 42.6+/-17.3 and 43.9+/-18.2 cmH2O, respectively). Similarly, the diaphragmatic movements were also comparable to the preoperative values, both during quiet and deep breathing (13.7+/-3.9 and 38.0+/-9.3 mm vs. 13.8+/-3.9 and 39.0+/-9.1 mm, respectively). There was no improvement of pulmonary functions in the early postoperative period. However, a long-term follow-up is needed to determine subsequent changes of these parameters.
