title: Preserved pleural integrity provides better respiratory function and pain score after coronary surgery.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. aumitgullu@yahoo.com
authors.forename: Ahmet Umit
authors.initials: AU
authors.lastname: Gullu
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Ekinci
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Sensoz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kizilay
authors.forename: Sahin
authors.initials: S
authors.lastname: Senay
authors.forename: Ahmet
authors.initials: A
authors.lastname: Arnaz
authors.forename: Turkan
authors.initials: T
authors.lastname: Coruh
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ates
authors.forename: Murat
authors.initials: M
authors.lastname: Akcar
mesh_terms: 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
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen