Postoperative respiratory muscle dysfunction: Pathophysiology and preventive strategies

  • N. S
  • M.J. M
  • M. E
  • 4

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Abstract

Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible. © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.

Author-supplied keywords

  • *postoperative complication/co [Complication]
  • *postoperative complication/et [Etiology]
  • *postoperative complication/pc [Prevention]
  • *postoperative complication/rh [Rehabilitation]
  • *postoperative respiratory muscle dysfunction/co [
  • *postoperative respiratory muscle dysfunction/et [
  • *postoperative respiratory muscle dysfunction/pc [
  • *postoperative respiratory muscle dysfunction/rh [
  • *postoperative respiratory muscle dysfunction/si [
  • *respiratory failure/co [Complication]
  • *respiratory failure/et [Etiology]
  • *respiratory failure/pc [Prevention]
  • *respiratory failure/rh [Rehabilitation]
  • *respiratory failure/si [Side Effect]
  • REM sleep
  • aging
  • apnea/co [Complication]
  • artificial ventilation
  • barotrauma
  • body position
  • breathing muscle
  • bronchus hyperreactivity
  • cerebrovascular accident/co [Complication]
  • chemoreceptor
  • consciousness
  • craniofacial development
  • craniofacial malformation
  • diaphragm paralysis/co [Complication]
  • diazepam
  • eye movement
  • halothane
  • homeostasis
  • human
  • hypercapnia
  • hypoglossal nerve
  • hypoxemia/co [Complication]
  • intestine pressure
  • intraabdominal hypertension
  • isoflurane/ae [Adverse Drug Reaction]
  • laparotomy
  • mechanical ventilator
  • mortality
  • muscle exercise
  • muscle relaxation
  • muscle training
  • neostigmine/ae [Adverse Drug Reaction]
  • neuromuscular blocking agent
  • obesity
  • opiate/ae [Adverse Drug Reaction]
  • patient positioning
  • perioperative period
  • peroperative complication/co [Complication]
  • phrenic nerve
  • priority journal
  • propofol/ae [Adverse Drug Reaction]
  • pulmonary rehabilitation
  • respiration depression
  • review
  • sleep disordered breathing
  • surgical injury/co [Complication]
  • thiopental
  • thorax wall
  • tumor necrosis factor alpha/ec [Endogenous Compoun

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Authors

  • Sasaki N.

  • Meyer M.J.

  • Eikermann M.

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