Effect of Preoperative and Postoperative Factors on Postoperative Dyspnea in Lung Cancer Cases Undergoing Thoracotomy

Abstract

We studied the relationship between postoperative dyspnea and age, type of surgical procedures, pre and postoperative pulmonary functions and postoperative sputum production in cases undergoing thoracotomy.
Dyspnea occurred in 65% of 127 cases after operation. The incidence and the degree of dyspnea were related to the type of surgical procedures and postoperative pulmonary function and sputum production. However, age and preoperative pulmonary function tests were not significantly associated with postoperative dyspnea. In lobectomy cases, 42% of 104 cases showed no dyspnea after operation, but 49% had mild dyspnea, 8% moderate and only 1% severe. On the other hand, 48% of 23 pneumonectomy cases complained of mild dyspnea, 35% moderate and 17% severe. Postoperative pulmonary function studies were helpful in identifying the degree of dyspnea after operation. Patients who stated dyspnea worsened after operation showed significantly greater drop in VC and FEVL0 as compared those who dyspnea showed no or mild change. The incidence of moderate and severe dyspnea was also increased in cases with large sputum volume compared to those with no or slight volume of sputum after operation. In addition, exercise tolerance tests were performed in 6 controls and 7 pneumonectomy cases. In control cases, all except 1 case completed stage VI exercise. By contrary, 3 of 7 cases completed of stage V exercise, 1 stage IV, 2 stage II and 1 stage I after pneumonectomy. Ventilation, oxygen consumption and heart rate increased markedly in pneumonectomy cases at lower level of exercise than that in control cases. The exercise tolerance test may be useful in assessment of cardiorespiratory reserve in cases before and after thoracotomy.