Recovery after Unilateral Phrenic Injury Associated with Coronary Artery Revascularization: Discussion (1)

Recovery after Unilateral Phrenic Injury Associated with Coronary Artery Revascularization: Discussion (1)Diaphragmatic paresis or paralysis is a well recognized complication of CAB surgery. The reported incidence of phrenic nerve palsy after bypass surgery has varied considerably depending on the methods used to evaluate the phrenic nerves. In two studies in which phrenic nerve electrophysiologic tests were utilized, phrenic nerve dysfunction was identified in ll2 and 9 percent of patients undergoing bypass surgery. Unilateral diaphragmatic paralysis, although rarely if ever life-threatening, may lead to postoperative respiratory complications. The most common of these is atelectasis, which was found in all five patients in this study ipsilateral to the side of paralysis. One of the patients with UDP in this study had prolonged postoperative mechanical ventilation (2.5 days). Weaning difficulties were encountered in five of 18 children with UDP after cardiothoracic surgery reported by Mickell et al. In adults after CAB surgery, one of the five patients reported by Markand et al required >48 h of ventilation. buy ortho tri-cyclen
Bilateral diaphragmatic paralysis or paresis, an uncommon but recognized complication of CAB surgery, results in marked respiratory morbidity. These patients typically require long-term postoperative ventilation, not being weaned until at least partial phrenic nerve recovery occurs. Although ventilation can be maintained with the intercostal-accessory muscles, ventilatory failure presumably develops because of increased postoperative demands on the intact muscles. The patient in this study with the longest duration of mechanical ventilation had evidence of concomitant right phrenic nerve paresis in addition to left phrenic nerve paralysis.

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