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Diaphragm dysfunction and respiratory insufficiency after upper abdominal surgery.

J Sprung1, E Y Cheng, N Nimphius

  • 1Department of Anesthesiology, Froedtert Memorial Lutheran Hospital, Milwaukee Wisconsin 53226.

Plucne Bolesti : Casopis Udruzenja Pneumoftiziologa Jugoslavije = the Journal of Yugoslav Association of Phthisiology and Pneumology
|January 1, 1991
PubMed
Summary

Diaphragm dysfunction significantly contributes to respiratory insufficiency after upper abdominal surgery, even with adequate pain management. This dysfunction, possibly due to reflex inhibition, impacts breathing and oxygen levels post-operation.

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Area of Science:

  • Medical research
  • Surgical outcomes
  • Respiratory physiology

Background:

  • Postoperative respiratory insufficiency is a common complication after upper abdominal surgery.
  • The roles of diaphragm dysfunction and pain in this complication require further elucidation.

Purpose of the Study:

  • To determine the contribution of diaphragm dysfunction and pain to respiratory insufficiency following upper abdominal surgery.

Main Methods:

  • In humans: pulse oximetry, pulmonary function tests (FVC, FEV1), and visual analog scale for pain.
  • In dogs: biplane videoroentgenography for diaphragm shortening and tidal volume, with phrenic nerve stimulation.

Main Results:

  • Humans showed significant reductions in FVC, FEV1, and SpO2 post-surgery, irrespective of pain control.

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  • Dogs exhibited reduced diaphragm shortening and tidal volume immediately after surgery.
  • Phrenic nerve stimulation confirmed no significant injury to diaphragm or nerves.

    • Conclusions:

    • Diaphragm dysfunction plays a major role in postoperative pulmonary insufficiency after upper abdominal surgery.
    • Afferent-mediated reflex inhibition of phrenic nerves is a potential cause of diaphragm dysfunction.