Position adopted for the post operative patient and its effect on tidal volume

Abstract

Most techniques used in general anaesthesia interfere with the function of major systems. General anaesthesia is known to cause post-operative atelectasis of the lungs which may lead to increased ventilation perfusion mismatch and complications such as pneumonia. In some instances it is recommended to keep the patient in the semi-recumbent position in the recovery area and the ward until patient is stabilized and in this position respiratory performance, functional residual capacity and clearance of secretions are improved when compared with the supine position,but in clinical practice it is a known fact that the patients may be kept in various positions post operatively. This study was directed to find out the common positions that the patients were nursed in post-operative wards and the impact of such positions on the ventilatory parameters of the patient. Methodology: A cross-sectional descriptive study was carried out amongst all patients who underwent major surgical and gynaecological interventions under general anaesthesia. Randomized sampling was done, and consented 60 patients were studied. Data was collected using an investigator administered questionnaire and spontaneous tidal volume was assessed first in the patients' nursed position and then once the patients are positioned to semi recumbent position, using a Wright's respirometer. The average of three consecutive breaths was obtained. Results: Total sample of 60 patients were studied out of which, 50 patients were found to have kept (83.33%) supine, 8 (13.33%) semi-recumbent and 2 (3.33%) were kept left lateral 3- 5 hours post-op irrespective of the surgery. Patients kept in semi-recumbent position had a mean tidal volume of 316.25ml (n=8 SD ± 39.978ml). The mean tidal volume in supine patients was 217.4 ml (n= 50 SD ±50.013ml) and the left lateral group was 255 ml (n=2), whereas after repositioning both groups to the semi-recumbent position, the mean was 283 ml (n=50 SD ± 52.109 ml) in the supine cohort and 315m l(n=2) in the left lateral cohort. The two-tailed P value is less than 0.0001.By conventional criteria; this difference is considered to be extremely statistically significant. Conclusion: Most of the patients in the post-operative wards were kept in the supine position irrespective of surgeries. Repositioning of them to the semi-recumbent position gives better ventilatory parameters. The staff should be instructed to position post operative patients in the semi recumbent position.