Post-anaesthetic respiratory complaints following endotracheal anaesthesia in lower abdominal obstetric and gynaecology surgery.

BACKGROUND

Postanaesthetic respiratory complications represent a significant negative aspect of surgical care.

OBJECTIVE

To assess the incidence and possible associated risk factors for postanaesthestic respiratory complaints following endotracheal anaesthesia in lower abdominal surgery in obstetric and gynecology patients in our hospital.

SETTING

A Teaching Hospital in Nigeria.

DESIGN

Prospective study

METHODOLOGY

All consenting adult patients, aged 16-45 years, undergoing caesarean section and major gynaecological abdominal operations, under general anaesthesia with endotracheal intubation, over a period of 8months, were studied. Postoperative respiratory symptoms, (sorethroat, hoarseness and cough), were assessed in the ward, by direct questioning method, daily for 5 days. Those presenting with cough had their chest examined, and fever (T degrees > 37 degrees C), was noted. Patients with positive chest signs had radiological examinations of the chest done for confirmation.

RESULTS

A total of 202 patients were studied. Out of these, 152 (75.2%) patients had various forms of postoperative respiratory complaints. Overall, it was observed that caesarean section patients were more likely, than gynaecology patients, to report these respiratory complications in the postoperative period (88.4% vs. 58.9%). This difference was statistically significant (p < 0.05). The incidence of sorethroat directly correlated with the size of the endotracheal tube used (r = 0.936). There was a statistically significant difference in the incidence of sorethroat between the caesarean section patients and gynaecology patients (p < 0.00), particularly with endotracheal tube sizes larger than 7.5mm ID (p < 0.03). Duration of intubation, which was slightly longer in gynaecology patients (mean = 72.48 +/- 30.62), and number of intubation attempts, did not have statistically significant effect on the incidence of respiratory complaints.

CONCLUSION

The use of small endotracheal tube sizes (< 8.5mm) should be preferred in women, particularly in obstetric anesthesia (6.5-7.5mm), to minimize the incidence of postoperative respiratory complications.