RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



a) |

BRIEF RESUME OF THE STUDY

Introduction:

“The term abdominal surgery broadly covers surgical procedures that involves

Opening the abdomen. (1)

During quiet breathing, the contraction of the abdominal muscles increases the intra abdominal pressure by lowering the ribs and flattening the abdomen there by pushing diaphragm upwards to achieve a better expiration.(2)

Recovery from abdominal surgery is primarily endangered by postoperative pulmonary complication, e.g. atelectasis, pneumonia which remains the major causes for postoperative morbidity and mortality (3) Based on many studies performed over a 40-year period reported incidence of postoperative pulmonary complication varies from 6% to 76% .( 4)

General anesthesia reduces functional capacity and predisposes to development of atelectasis and hypoxemia.( 4 )

Functional disruption of respiratory muscles such as intercostals and abdominal muscles by incisions even after surgical repair may impair their effectiveness. Like anesthesia, surgical trauma can also disrupt normal co-ordination of respiratory muscle action leading to persistent decrease in functional residual capacity and vital capacity, which can last for several days after surgery.( 5 )

A major contributor to the decreased lung volume after upper abdominal surgery is breathing pattern characterized by decreased tidal volume, increased respiratory rate and absence of signing .( 4)

Breathing exercise actively exerts the ventilatory muscles and through the recruitment of motor units increases the strength of ventilatory muscles. Improved muscle strength can be used to achieve maximum emptying. (2)

Incentive spirometer is activated by an inspiratory effort; hence incentive spirometer is used clinically as part of the routine prophylactic and therapeutic regimen in perioperative respiratory care. Incentive spirometer technique is activated by an inspiratory effort that is breathing is visualized by an uplifted plate or ball in a transparent cylinder during sustained inspiration.(3)

The relationship between pre-operative variables and postoperative pulmonary complication in surgical patients has been the subject of numerous studies. Despite recent advances in pre operative management post operative respiratory morbidity is still a common problem, especially following upper abdominal surgery.( 6)

Deep breathing and incentive spirometry may increase inspiratory reserve volume, promote maximum alveolar inflation and improve ventilation-perfusion ratio. Deep breathing may actually reverse microatelectasis related to hypoventilation. The incentive spirometer also provides a goal for the patient. (7) | |

| | |

| |Need for the study: |

| |During review of literature we found no studies which covered both high risk and low risk patients treated with deep breathing exercise and|

| |incentive spirometer exercise. Also comparative studies exhibited contradictory results. Hence need arises to measure and compare the |

| |effectiveness of deep breathing exercise and incentive spirometer exercise following abdominal surgery on peak expiratory flow rate, |

| |thoracic cage expansion and other cardiovascular parameters.. |

| |. |

| |RESEARCH HYPOTHESIS: |

| |Hypothesis: There will be difference in effectiveness of deep breathing exercises and incentive spirometer exercises following abdominal |

| |surgery on peak expiratory flow rate, thoracic cage expansion and other cardiovascular parameters. |

| |. |

| |Null hypothesis: There will be no difference between effectiveness of deep breathing exercise and incentive spirometer exercise following |

| |abdominal surgery on peak expiratory flow rate, thoracic cage expansion and other cardiovascular parameters. |

| | |

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| |REVIEW OF LITERATURE |

| |Usually a complication is defined as an unexpected second disease entity that requires special treatment. The most common pulmonary |

| |complications are atelectasis, respiratory infections, bronco constriction and respiratory failure. (7) |

| | |

| |After abdominal surgery functional residual capacity can decrease to 60 % to 70% of pre operative levels and may return to only 70% of |

| |normal by postoperative 7 to 10 days. This is associated with a further reduction in compliance, possibly due to collapse of air spaces. |

| |(8) |

| | |

| |Postoperative hypoxemia results predominantly due to gas exchange impairment during anesthesia. As a result of this there is reduced tone |

| |in the muscles of the chest wall and alterations in bronchomotor and vascular tone; these changes persist into the postoperative period. In|

| |addition, there is an abnormality of control of breathing which results in episodic obstructive apnea. These episodes continue for several |

| |days after operation. (9) |

| | |

| |The incidence of hypoxemic events in postoperative adult patients was noted by monitoring the peripheral arterial oxygen saturation (SpO2) |

| |with pulse oximeter. |

| |All these patients had Sp02 >97% before transfer to the recovery room. This study revealed that the overall incidence of hypoxemia in these|

| |patients was 42%. On arrival in the recovery room 28% patients had Sp02 ................
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