Surgery for Adults

Question 1

Effects of the surgical process on respiratory function: Lung Volumes

Answer 1

Vital Capacity (VC) can ↓ to 40% of preoperative values
Functional Residual Capacity (FRC) may gradually ↓ to 70% at 24h postoperatively

Changes may persist for 5-10 days. Greatest reduction at ~1st or 2nd day after surgery.

Question 2

Risk factors for postoperative pulmonary complications: DVT

Answer 2

Identification of any pain in the calf on Ax is important as it may indicate a Deep Vein Thrombosis (DVT).

Question 3

Risk factors for postoperative pulmonary complications: factors

Answer 3

• Duration of anaesthesia >180’
• Type of surgery performed (upper abdominal)
• Presence of preoperative respiratory problems (e.g. COPD)
• Current smoking (within last 8 weeks)
• Reduced level of preoperative activity (measured using a questionnaire)

Question 4

Types of surgery

Answer 4

> Abdominal: e.g. laparoscopy
Thoracic: e.g. carcinoma of the lung
Cardiac: e.g. coronary artery disease, MI

Question 5

Pneumothorax

Answer 5

> Primary spontaneous: most common. Usually results from the rupture of a tiny bleb at the apex of the lung.
Secondary: occurs as a result of underlying lung disease such as COPD or lung abscess.
Traumatic: occurs after penetrating trauma such as by a rib fx, knife or gunshot wound. Usually accompanied by haemothorax.
Tension: results when the site of air leak acts as a one-way valve so that air enters the pleural space during inspiration but cannot escape during expiration.

Question 6

Underwater Seal Drainage Units (UWSD)

Answer 6

System used specifically to drain air and/or fluid from the thoracic cavity in order to regain and/or maintain re-expansion of the lung by re-establising normal negative pressure in the pleural space.

Question 7

Underwater Seal Drainage Units (UWSD): Assessment

Answer 7

> Swing: intrapleural pressure changes that occur during inspiration and expiration are transmitted to the drainage system. Small mvmt during quiet breath, large mvmt during coughing or increased respiratory effort.

> Bubbling: in the underwater seal chamber indicates an air leak (from the pleural space). In the suction chamber indicates suction is applied correctly.
Bubbling on coughing = small air leak
Bubbling on expiration = moderate air leak
Bubbling throughout ins and exp = large air leak

> Drainage: when drainage is reduced to 100 ml in 24h the tube is removed. Large amounts of blood draining over a short period may indicate haemorrhage.

> Suction: when wall suction is applied = gentle bubbling.
No bubbling in suction chamber = not enough suction.
Vigorous bubbling won’t increase amount of suction.

Question 8

Key points in PT treatment techniques

Answer 8

► To date no specific treatment techniques have been found to be superior to any another.
► Preoperative tm allows PTs to assess pt risk factors and may be an effective tm in its own.
► The additional value of incentive spirometry (IS) over other forms of postoperative prophylaxis has not been supported in surgical pt.
► Continuous positive airway pressure (CPAP) is most commonly used as a second-line tm intervention in the mgmt of surgical pt.
► Mobilization of pt has been included in most of the research assessing effectiveness of PT tm as a whole. The effectiveness of mobilization alone after abdominal, Tx and oesophageal surgery needs further investigation.
► In cardiac surgery, pre and postoperative assessment and/or mobilization may be the only tm required in the acute postoperative period.
► The place of PT in the postoperative rehab and fast tracking of surgical pt needs further clarification.