Respiratory Conditions Post Op

Postoperative Respiratory Complications

The term postoperative respiratory/pulmonary complication encompasses almost any complication affecting the respiratory system after anaesthesia and surgery. These complications occur commonly, have major adverse effects on patients, and are difficult to predict.

Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, leading to respiratory complications.

There is a wide spectrum of pulmonary complications which are as follows:

• Atelectasis-resulting in post-operative hypoxaemia (commonest complication)
• Pneumonia
• Bronchitis
• Bronchospasm
• Exacerbation of previous lung disease
• Pulmonary collapse due to mucus plugging of the airways 

What causes Respiratory complications post Operatively?

Patient-related risk factors include:

• Age >65 years
• Smoking
• COPD
• Asthma
• Obesity
• General Health – poor functional status and reduced exercise capacity
• Obstructive sleep apnoea
• Preoperative anaemia

Surgical risk factors include:

• Duration of surgery
• Type of surgery
• Site of surgery – Compared with ‘other types of surgery’, the incidence of pneumonia is significantly higher after abdominal aortic aneurysm repair, thoracic, upper abdominal, or neck surgery, neurosurgery, and major vascular surgery.
• Type of surgery – laparoscopy has fewer complications than open
• Requiring mechanical ventilation > 48 hours post surgery
• Nasogastric Tube – presence associated with post operative pneumonia
• Optimization of co-morbidities
• Smoking cessation
• Good post-operative analgesia – enables the patient to take deeper breaths and cough more effectively to clear secretions
• Pre-operative physiotherapy
  • to provide adequate lung expansion and reduce atelectasis
  • inspiratory muscle training
  • Advice and training on airway clearance techniques
  • Aerobic exercise
• Post-operative Physiotherapy
  • Deep breathing exercises and airway clearance techniques
  • Use of Incentive Spirometry
  • Early mobilisation and ambulation
  • Promote active cough and advice and education on the importance of same
• Continuous Positive Airway Pressure
• Optimisation of pharmological treatment such as inhalers and nebulisers
• Improve nutritional status
• Intra and post – operative rapid correction of hypoxaemia
• Oral Hygiene
• For high risk patients, surgical time should be minimised
• Fast correction of hypoxaemia post operatively

What would physiotherapy treatment for Respiratory Complications pre and/or post operatively involve?

At Respiratory Physiotherapy Ireland, our physiotherapists will ensure you receive specialised treatment for your condition. We can offer you personalised physiotherapy pre and/or post operatively to help prevent or treat respiratory complications. Depending on a detailed assessment, you may be offered some of the following treatments:

• Secretion clearance:
  • Active Cycle of Breathing
  • Autogenic Drainage
  • Positive Expiratory Pressure (PEP)
  • Oscillating positive expiratory pressure
  • Effective / productive coughing techniques.
  • Supported coughing techniques (if required secondary to pain, fear, anxiety)
  • Postural drainage in sitting and lying.
  • Manual techniques, including percussion and vibrations 

• Breathing techniques:
  • Deep Breathing exercises – performing deep-breathing exercises using an incentive spirometry may help remove secretions and increase lung volume. 

• Education and Advice:
  • Illness cause
  • Prevention of respiratory complications post operatively
  • Medication management
  • Mobility and exercise

• Exercise Assessment and Prescription
  • Those experiencing dyspnoea on exertion (even mild dyspnoea) may benefit from a formal exercise program. Exercise can also prevent post-operative respiratory complications. A formal exercise program generally includes aerobic and resistance training. Exercise training includes intensity, frequency, duration, type, mode and progression based on your condition.