Effects of general anesthesia on body systems and physiotherapy management to avoid complications

1. PREVENTION OF COMPLICATIONS
OF GENERAL ANAESTHESIA POST
ABDOMINAL SURGERIES
- AKHILA NATESAN

2. GENERAL ANAESTHEISA
 General anaesthesia is used in abdominal
surgeries
 Produces unconsciousness, amnesia and
analgesia.
 Changes lung mechanics, lung defences,
gas exchange.

3. PRE
INDUCTI
ON
• Anti anxiety drug – midazolam (BZD)
• Pre emptive analgesia – fentanyl (opiod)
INDUCTI
ON
• Propofol, thiopental
MAINTAIN
ENCE
• Inhalational agents – Sevoflourane with
nitrous oxide or air.
REVERS
AL
• Inspired anaesthetic is scaled back
• Neostigmine or suggammadex
Procedure of administration of GA

4. EFFECTS ON RESPIRATORY FUNCTION
GENERAL
ANAESTHESIA
+
POST
OPERATIVE
PAIN
+
RECUMBENCY
+
IMMOBILITY
+
ADMINISTRATIO
N OF DRUGS
•LUNG VOLUME
•FUNCTIONAL
RESIDUAL CAPACITY
•CLOSING CAPACITY
•MUCOCILIARY
CLEARANCE
•RESPIRATORY
MUSCLE FUNCTION

5. LUNG VOLUME
RESTRICTIVE LUNG DEFECT
 Vital Capactiy decreases by 40%
 Functional residual capacity reduces by
70%
•Greatest reduction on first and
second post op day
•Even mild obesity – significant
reduction in FRC

6. FUNCTIONAL RESIDUAL CAPACITY
 FRC is the volume of air left in lungs at end
of quiet expiration.
Keeps the small airways open at the end of
expiration

7. RELATIONSHIP OF FRC TO BODY
POSITION AND CLOSING CAPACITY

8. CONSEQUENCES
 Reduced compliance
 Atelectasis
 V/Q mismatch
 Hypoxaemia
Therefore, supplemental oxygen is given.

9. MUCOCILIARY DYSFUNCTION
FACTORS CAUSING :
 Anaesthetic agents.
 Endotracheal intubation
 Pain medication.
 Atelectasis
 Reduced lung volume.
 Reduced cough efficiency.
 Increased viscosity of secretions.

10. RESPIRATORY MUSCLE FUNCTION
 Diaphragm excursion decreases – lasts up
to 1 week.
 Occurs due to –
•Effect of GA
•Post operative pain.
•Incisions of abdomen.
•Reflex inhibition of phrenic nerve – few
evidences

11. POST OPERATIVE PULMONARY
COMPLICATIONS
 Reduced lung volume + mucociliary dysfunction +
respiratory muscle dysfunction
inevitable pulmonary complications.
 However, its progression is self limiting and
transient.
 PPC - A pulmonary abnormality that produces
identifiable disease or dysfunction that adversely
affects the clinical course.
 Exact mechanism of how “clinically significant” PPC
occurs only in some patients is unknown.
 PPC causes post operative morbidity and mortality
and significant increase in length of stay

12. HOW TO DIAGNOSE

13. ROLE OF PHYSIOTHERAPIST
Duration of anaesthesia >
180 minutes.
 Type of surgery
performed – upper
abdominal.
 Presence of pre operative
respiratory problems eg.
COPD.
 Current smoking ( within
8 weeks).
 Reduced level of pre
operative activity.
(Questionnaire)
In addition -
 Advanced age.
 American society of
anaesthesiologist (ASA)
classification 3-5.
 Functional dependence.
 Respiratory and cardiac disease.
 Serum albumin < 3 gm/dl.
 Sleep apnoea.
 Significant intra operative blood
loss.
 Oesophageal surgery
NOT IMPORTANT
•OBESITY
•ASTHMA
•HIP/ LOWER ABDOMINAL
SURGERY
1) Determine risk factor for developing PPC –

14. ASA SCORE

15. PREHABILITATION
ADVANTAGES
• Reduces risk of
PPC.
• Reduced time to
extubation.
• Improved aerobic
and functional
outcome.
INTERVENTIONS
• Education
• Whole body
exercise training.
( CVS +
STRENGTH)
• Breathing
exercise.
• IMT training.
• Diet optimisation.
PROGRAM
• F - 3 – 7 days per
week. (2-4 wks
preop)
• I – aerobic-
60-65% Hrmax.
Strength –
60% 1 RM .
IMT – 30%MIP.
• T – 20- 30 mins.
• T – Strength,
Aerobic,
Respiratory
muscle training.

16. POST OPERATIVE REHABILITATION
In case of PPC –
Early upright positioning.
Mobilisation.
Chest Physiotherapy.
Incentive Spirometry if conscious.
Other –
Pain management.
Functional independence.
Aerobic training.

17. SUMMARY
 A 70 year old male vegetable vendor is scheduled for a right
hemicolectomy. He has a history of episode of angina 5 yrs
ago, had undergone angioplasty. Smokes 2 packs a day. He
sells vegetables by pushing hand cart for 7 hrs a day.
Determine the risk of developing PPC and plan a pre and post
rehabilitation program.

18. QUESTIONS

19. REFERENCE
Doa El Ansary, Julie C Reeve, Linda
Denehy. Upper abdominal and
cardiothoracic surgery for adults. In :
Eleanor Main and Linda Denehy.
Cardiorespiratory Physiotherapy Adults and
Paediatrics. 1st edition. Elsevier; 2016.p.
513 – 570.

20. THANK YOU