The effect of respiratory physiotherapy on the pulmonary function of women following cesarean section under general anesthesia

International

Journal of Gynecology & Obstetrics 47 (1994) 177-178

Letter to the editor

The effect of respiratory physiotherapy on the pulmonary function of women following cesarean section under general anesthesia B. Kaplan *aTb,D. Rabinerson”,

A. Nerib

aDepartment of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tikva. Israel bSackler Faculty of Medicine. Tel-Aviv University. Tel-Aviv, Israel

Received 5 November

Keywords:

Cesarean

section;

1993; revision

Complications;

General

received

anesthesia;

Pulmonary complications play a major role in postoperative morbidity and mortality. It is generally accepted that patients undergoing abdominal surgery require some form of prophylactic physiotherapy [l], as long periods of anesthesia may be followed by complications such as atelectasis [2] and postoperative fever. Studies comparing the postoperative morbidity of cesarean sections under general and epidural anesthesia found it to be significantly higher after general anesthesia. Prophylactic lung expansion maneuvers are employed in more than 95% of hospitals in the USA [3]. Such treatment is routinely administered at our institution (3000 deliveries annually, 12.5% of which are by cesarean section). The scope of the present study was to examine the efficacy of respiratory physiotherapy in the prevention of postoperative pulmonary complications in patients undergoing cesarean section under gen-

* Corresponding

author.

0020-7292/94i$.O7.00 0 1994 International SSDI 0020-7292(94)02175-X

Federation

15 May 1994; accepted

of Gynecology

Respiratory

3 June 1994

physiotherapy

era1 anesthesia. One hundred twenty women who underwent cesarean section under general anesthesia were randomly divided into two groups of 60 women each in the study and control groups. The study group received respiratory physiotherapy on the first 3 postoperative days. Patients in the control group received no postoperative physiotherapy at all. Both groups were evaluated daily by a physiotherapist who was not informed about the group classification of the patient under examination. The variables evaluated included information on coughing, presence of phlegm, body temperature, chest palpation and auscultation, and evaluation of lung and chest expansion according to the Frownfelter method [4]. All cesarean sections in both groups were performed using the low abdominal transverse incision. The study and control groups were matched with respect to maternal age, maternal weight at delivery, parity, and duration of general anesthesia during surgery. In the postoperative clinical evaluation performed by the and Obstetrics

Lurrers to the editor /Inr. J. Gynecol. Obstet. 47 (1994) 177- I78

178

Table I Clinical postoperative evaluation for study and control groups by evaluating physiotherapist Test results

Chest auscultation

SG CG

Chest expansion

SG CG

Cough test

SG CG

Recommendation

SG CG

Normal Pathologic Normal Pathologic Normal Pathologic Normal Pathologic Productive Non-productive Productive Non-productive NT DNT NT DNT

No. of patients Postoperative day I

Postoperative day 2

Postoperative day 3

51 9 45 I5 60 0 51 9 I8 42 24 36 I8 42 24 36

57 3 51 3 60 0 60 0 6 54 I2 48 3 57 0 60

60 0 60 0 60 0 51 3 0 60 0 60 0 60 0 60

SG, study group; CG, control group; NT, Need further treatment; DNT. do not need further treatment.

physiotherapist (Table l), statistical analysis using the chi-squared test showed no significant difference between groups for each of the variables mentioned. In view of our results, the need for respiratory physiotherapy after a low transverse abdominal incision cesarean section under general anesthesia, with its financial implications, is of no benefit. Such an operation, combined with general anesthesia of short duration (25-60 min in our study), the site of incision, the incision itself being relatively small, together with maternal age, do not put the patients at high risk for postoperative pulmonary complications, hence there is no need for preventive respiratory physiotherapy in such cases. This does not, however, include women with previously known respiratory problems. Early mobilization, adequate analgesia and patient education regarding respiratory physiotherapy by the department’s nurses are therefore sufficient to prevent pulmonary morbidity in such patients.

References 111 Hall JC, Tarala R, Harris J et al.: Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet 337: 953, 1991. 121 Christensen EF, Schultz P, Jensen OV et al.: Postoperative pulmonary complications and lung function in highrisk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia. Acta Anaesthesiol Stand 35: 97, 1991. I31 O’Donohue WJ Jr: National survey of the usage of lung expansion modalities for the prevention and treatment of postoperative atelectasis following abdominal and thoracic surgery. Chest 87: 76, 1985. [41 Frownfelter D: Chest assessment and clinical evaluation. In: Chest Physical Therapy and Pulmonary Rehabilitation (ed DL Frownfelter), p. 129. Mosby Year Book Medical Publishers, Chicago IL, USA, 1978.