Pulmonary function 4 months after coronary artery bypass graft surgery

AbstractThe objective of this study was to describe the pulmonary function and pain 4 months after coronary artery bypass graft surgery. Twenty-five male patients performed pulmonary function tests before surgery, on the 4th postoperative day and 4 months after surgery. A severe reduction in pulmonary function was present after surgery. Four months postoperatively, the patients still showed a significant decrease (6–13% of preoperative values) in vital capacity (P<0.001), inspiratory capacity (P<0.001), forced expiratory volume in 1 s (P<0.001), peak expiratory flow rate (P<0.001), functional residual capacity (P = 0.05), total lung capacity (P<0.001) and single-breath carbon monoxide diffusing capacity (P<0.01). Residual volume and single-breath carbon monoxide diffusing capacity per litre of alveolar volume had returned to the preoperative level. Four months postoperatively, the median values for sternotomy pain while taking a deep breath was 0.2 and while coughing 0.3 on a 10 cm visual analogue pain scale. In conclusion, a significant restrictive pulmonary impairment persisting up to 4 months into the postoperative period was found after CABG. Measured levels of pain were low and could not explain the impairment

The safety of one, or repeated, vital capacity maneuvers during general anesthesia

A vital capacity maneuver (VCM) (inflating the lungs to 40 cm H(2)O for 15 s) is effective in relieving atelectasis during general anesthesia or after cardiopulmonary bypass (CPB). The study was undertaken to investigate the safety of one or repeated VCM. Five groups of six pigs were studied. Two groups had general anesthesia for 6 h and one group received a VCM every hour. Three other groups received CPB. VCM was performed after CPB in two of these groups. VCM was then repeated every hour in one of the groups. Lung damage was evaluated by extravascular lung water (EVLW) measurement, light microscopy, and the half-time (T(1/2)) of disappearance from the lung of a nebulized aerosol containing (99m)Tc-DTPA. No changes were noted in extravascular lung water. The pigs subjected to VCM decreased their T(1/2). In the groups exposed to repeated VCM, T(1/2) remained lowered (CPB pigs) or decreased over time (non-CPB pigs). No lung damage could be seen on the morphology study. These results suggest that one VCM is a safe procedure. The increase in lung clearance of (99m)Tc-DTPA not associated with an increase in lung water when VCM is repeated may have been caused by an increase in lung volume. Therefore, repeated VCM also appears to be safe. IMPLICATIONS: This study demonstrates in an animal model that inflating the lung once or repeatedly to the vital capacity is a safe procedure. This maneuver, also called the vital capacity maneuver, can be used to relieve lung collapse which occurs in all patients during general anesthesia