Preserved pleural integrity provides better respiratory function and pain score after coronary surgery.
OBJECTIVE
Patients undergoing surgical procedures through median sternotomy have reduced pulmonary function in the postoperative period. Our study was designed to evaluate the effect of pleural integrity in terms of respiratory functions and pain score after coronary bypass procedures.


METHODS
In a randomized, prospective study we evaluated 320 patients in two groups. Group I (n = 160) patients were the patients whose pleural cavity was intact while internal mammary artery (IMA) harvesting, and in group II (n = 160) the pleural cavity of the patients was opened. They matched in terms of postoperative respiratory functions and pain score.


RESULTS
FEV1 (%) and FEV1/FVC levels at the postoperative fifth day were significantly lower in group II (I = 71.5 +/- 4.9 vs. II = 63.5 +/- 8.3 and I = 24.1 vs. II = 22.1), respectively (p < 0.05). The rate of postoperative pleural effusions and atelectasis at the postoperative fifth day were significantly higher in group II (I = 35%, 15% vs. II = 48%, 35%), respectively (p < 0.05). The pain score was higher in group II at postoperative fifth day.


CONCLUSIONS
All patients undergoing cardiac surgery suffer deterioration in pulmonary functions. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions. Moreover, preserving pleural integrity provides beneficial effects on pain score after coronary operations especially in the early postoperative period.
Gullu
Ahmet Umit
AU
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. aumitgullu@yahoo.com
Ekinci
Abdurrahman
A
Sensoz
Yavuz
Y
Kizilay
Mehmet
M
Senay
Sahin
S
Arnaz
Ahmet
A
Coruh
Turkan
T
Ates
Mehmet
M
Akcar
Murat
M
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D035422:Pleural Cavity / Q000601:surgery*; D010996:Pleural Effusion / Q000209:etiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology; D013249:Sternum / Q000601:surgery; D014797:Vital Capacity
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen