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      Cardiac surgery in patients with previous pneumonectomy

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      1 , , 1 , 1
      Journal of Cardiothoracic Surgery
      BioMed Central

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          Abstract

          Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following pneumonectomy makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. With improvement in life expectancy and better results following cardiac and pulmonary operations increasing number of patients are likely to be subjected to both of these operations during their lifetime.

          There is paucity of data in the literature on the subject of cardiac surgery subsequent to previous pneumonectomy. We report our experience on performing cardiac surgery following pneumonectomy to highlight certain important features that we think are important while managing these patients.

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          Most cited references17

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          Preventing postoperative pulmonary complications: the role of the anesthesiologist.

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            Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery.

            This randomized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery. A group of 174 patients received chest physiotherapy including breathing with pursed lips, huffing and coughing, and information about the importance of early mobilization. In addition high-risk patients were given resistance training on inspiration and expiration with a mask. The resistance used during inspiration was -5 cmH2O and that during expiration +10 cmH2O. The control group (194 patients) received no information or treatment unless a pulmonary complication occurred. Oxygen saturation on postoperative days 1-3 was significantly greater in the treatment group. Treated patients were mobilized significantly earlier. No difference was noted in peak expiratory flow rate or forced vital capacity. Postoperative pulmonary complications occurred in 6 per cent of patients in the treatment group and in 27 per cent of controls (P < 0.001). In high-risk patients the numbers with pulmonary complications were six of 40 and 20 of 39 respectively. Pulmonary complications were particularly common in patients with morbid obesity. Preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen saturation after major abdominal surgery.
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              Respiratory dysfunction after uncomplicated cardiopulmonary bypass.

              Respiratory dysfunction is a well-recognized complication of cardiac operations. To quantify its current incidence and severity after uncomplicated cardiopulmonary bypass, serial measurements of arterial oxygen tension (PaO2), alveolar-arterial oxygen gradient (AaO2), and percentage pulmonary shunt fraction (%PSF) measured by a noninvasive technique were made in 129 patients (age, 59 +/- 8 years (mean +/- standard deviation) with good left ventricular function (left ventricular end-diastolic pressure < 15 mm Hg) undergoing isolated coronary artery operations (group 1) and 30 patients undergoing general surgical procedures (group 2). Measurements were made before operation and on the first, second, and sixth postoperative days. Seven patients in group 1 who required prolonged ventilation were excluded from further study. In group 1, between the preoperative and second postoperative days, there was a marked fall in PaO2 [89 +/- 11 versus 57 +/- 9 mm Hg; p < 0.001] and a marked increase in the AaO2 gradient [18 +/- 10 versus 50 +/- 11 mm Hg; p < 0.001)] and %PSF [3 +/- 1% versus 19 +/- 6%; p < 0.001)] with only modest improvement by the sixth postoperative day [PaO2, 67 +/- 11 mm Hg; AaO2, 45 +/- 11 mm Hg; %PSF, 15 +/- 4]. There were similar but less severe changes in PaO2 and AaO2 gradients in group 2 patients, with a return to baseline values by day 6.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central
                1749-8090
                2008
                1 March 2008
                : 3
                : 11
                Affiliations
                [1 ]Department of Cariothoracic Surgery, Cardiothoracic Centre, Thomas Drive, Liverpool, UK
                Article
                1749-8090-3-11
                10.1186/1749-8090-3-11
                2270840
                18312686
                5bed18d7-0bc0-4d99-94e4-7f08149b3b0d
                Copyright © 2008 Ghotkar et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 June 2007
                : 1 March 2008
                Categories
                Case Report

                Surgery
                Surgery

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