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There were 35 (or 4.6 per cent) pulmonary complications following 761 operations for hernias and for pathologic conditions resulting from disease of the appendix in a station hospital during the past two years. There was no mortality following these operations.
Pulmonary complications were present in 10.4 per cent of 49 operations for severe appendicitis and 2.6 per cent of 312 operations for uncomplicated appendicitis.
There were 22 (or 5.5 per cent) pulmonary complications after 400 operations for hernia.
Atelectasis was present alone or in combination in 17 cases and bronchitis or bronchopneumonia was present in 17 cases. There was one small pulmonary infarct.
We do not believe that the use of spinal anesthesia is a factor in the development of postoperative pulmonary complications.
The presence of infection of the upper respiratory tract, sinuses, teeth, tonsils, or the lungs will increase the development of pulmonary complications.
Prevention of atelectasis is best accomplished by the preservation and activation of the normal cough by reassurance, adequate explanation of the objective to the patient, and the employment of turning, deep breathing, slapping on the back, and CO2 inhalations as adjuvants of psychotherapy all combining to result in normal expectoration by the patient of the bronchial secretions.
Sulfadiazine and sodium bicarbonate are used routinely with pulmonary complications because of the frequent impossibility of differentiating infection from atelectasis early in the process and because atlectasis is frequently associated with infection.
Catheter aspiration or bronchoscopy is advocated if conservative measures fail.
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Received: November 21, 1944
© 1945 Published by Elsevier Inc.