The study
will be conducted on patients undergoing elective major abdominal surgeries.
The written and informed consent will be obtained from all the patients.
One hundred
and thirty-nine patients scheduled for elective major abdominal surgeries will
be enrolled in this study.
A brief
history taking would be done. History of known comorbidities, history of
smoking, if a smoker the number of cigarettes per day, the number of years of
smoking and the last smoking would be noted.
The
six-minute walk test will be performed indoor along a flat surface in a
straight corridor 30m long, with 180 degree turns every 30m near the
pre-anesthesia clinic. The resuscitation and crash cart equipment will be made
available.
The patient’s
heart rate, oxygen saturation will be monitored throughout the test.
The
patients would be monitored continuously for any adverse reaction throughout
the procedure.
The ability
of the patients to complete the test will be noted. If the patients are not
able to complete the test, then the number of minutes, they are able to walk
will be noted.
Patients
posted for major abdominal surgeries will be premedicated with T. Alprazolam
0.25mg, T. Ranitidine 150mg and T. Metoclopramide 10mg, the night before
surgery and on the morning of the surgery.
The
patients posted for major abdominal surgeries will all be administered general
anesthesia with epidural anesthesia. Patients in the premedication room will be
monitored for the heart rate, blood pressure, oxygen saturation. Patients will
be shifted to the operating room. Patients will be premedicated with Inj.
Midazolam 0.01-0.02mg/kg and Inj. Fentanyl 2mcg/kg. Then induced with Inj.
Propofol 2mg/kg and muscle relaxation with Inj. Vecuronium 0.08-0.12mg/kg.
Patients will be intubated with endotracheal tube and depth of anesthesia would
be maintained with 50% O2 and 50% N2O and 1 MAC Sevoflurane.
Epidural
will be activated intra-operatively with levobupivacaine 0.25% 6-8ml and topped
up every 2 hours with 3-6ml.
Patients
will be administered Inj. Fentanyl 0.5mcg/kg every hour till the end of
surgery. Relaxation will be maintained with vecuronium 0.01mg/kg.
Intra-operatively,
the patient’s heart rate, blood pressure, respiratory rate, oxygen saturation
will be monitored and noted.
At the end
of surgery, patient will be extubated with Neostigmine (0.07 mg/kg) and
glycopyrrolate (0.014 mg/kg).
Patient
will be shifted to ICU for monitoring and epidural infusion.
Patients
with be given 0.125% Levobupivacaine with Fentanyl 2mcg/ml epidural infusion @
4-6ml/hour postoperatively.
The Patient
is said to have post-operative pulmonary complications, if any of the following
happens:
>prolonged
mechanical ventilation>48hrs
>atelectasis
(radiological diagnosis)
>bronchitis
>pneumonia
>acute
respiratory failure
>Fall in
oxygen saturation (<92% in Room air)
>Patients requiring oxygen support >24hours.
>Development of new history of cough with sputum
production.
>Persistent tachypnoea >30 for >24hours.
The results
of the test would be documented.
The
patients would be monitored for post-operative pulmonary complications during
the hospital stay.
The
criteria for ICU discharge are:
>Patient
should be pain free.
>Hemodynamically
stable.
>Urinary
catheter removed.
>Patient
started on orals.
The length
of ICU stay for the patients will also be studied.
The
patients would be followed up through phone call every week till 30days.
The
correlation between smoking, age and weight and incidence of post-operative
pulmonary complications will also be studied.
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