Surgical approach does not affect perioperative respiratory morbidity in living donor nephrectomy: comparison between anterior subcostal incision and flank incision.

BACKGROUND: Living donor nephrectomy has been a routine surgical procedure that significantly increased the number of organs for patients with end-stage renal disease. Upper abdominal surgeries, especially when performed with an open approach, usually lead to a postoperative reduction in lung volumes and pulmonary compliance, which may predispose to the development of atelectasis and pulmonary mucus retention, important risk factors for postoperative pulmonary infections. AIM: This study sought to compare lung function impairment, pain, and the incidence of postoperative pulmonary complications among live nephrectomy donors undergoing either an open donor nephrectomy through an anterior subcostal incision (SC) or a flank incision (FL). PATIENTS AND METHODS: Between 2006 and 2008, 110 subjects (44 SC/66 FL) had their pulmonary functions (spirometry) and pain (visual analog scale) evaluated preoperatively as well as on postoperative days 1, 2, 3, and 5. Postoperative pulmonary complications were evaluated daily by a pulmonary physician. A chest radiograph was obtained on postoperative day 2 to evaluate the presence of atelectasis. RESULTS: Both groups were similar before surgery. Patients in both groups showed decreased pulmonary function from day 1 to 3 (P < .05). Subjective pain was increased until day 5 (P < .05) with a higher incidence of atelectasis among 36% FL vs. 25% SC. (P > .05). CONCLUSION: Living donor nephrectomy through either a flank incision or an anterior subcostal incision showed similar degrees of postoperative pain, decreased lung function, and pulmonary complications.

Characteristics of hypoxemic episodes in very low birth weight infants on ventilatory support.

OBJECTIVE: To characterize hypoxemic episodes in very low birth weight infants with mechanically ventilated lungs and to describe their natural history and the effect of body position. STUDY DESIGN: Tidal volume, respiratory rate, oxygen saturation, heart rate, and body movement were continuously recorded in 10 very low birth weight infants who exhibited episodes of hypoxemia during mechanical ventilation (birth weight, 810 +/- 133 gm; postconceptional age at study, 30 +/- 1.6 weeks). Frequency of hypoxemic episodes was compared in both prone and supine positions. RESULTS: Seventy-eight percent of hypoxemic episodes began in association with body movement as well as heart rate acceleration. Thereafter the spontaneous and delivered minute ventilation both decreased during the first 15 seconds of hypoxemia. The former decrease was due to a significant decrease in frequency of spontaneous respiration, whereas the latter was associated with a significant decrease in delivered tidal volume. Minute ventilation returned to normal before recovery of oxygenation. A change in body position from supine to prone significantly decreased the frequency of hypoxemic episodes. CONCLUSION: Hypoxemic episodes in infants who are on ventilatory support are characterized by (1) movement and cardioacceleration at initiation; (2) a decrease in both spontaneous and delivered minute ventilation, and (3) a lower incidence in the prone position. We speculate that spontaneous movement during sleep can trigger cardiopulmonary reflex responses that initiate and propagate these episodes.