The respiratory system consists of the nose and nasal passages, part of the pharynx, the larynx, the trachea with its subdivisions, the bronchi and the lungs (Hollinshead 1985).
Many advances have been made in surgical procedures but surgery still carries considerable risk to the patient, both adult and child (Webber 1993). No matter how simple and straightforward an operation, or how physically fit the patient is before he undergoes it, there are always certain risks, which cannot be avoided, though preventive measures can lessen their incidence. Some of the complications that may follow surgery are respiratory problems, thrombosis, wound infections, pressure sores, hemorrhage, muscle wasting and impairment of function and cardiac arrest. Respiratory complications are liable to follow any operation in which general anesthesia is used. They are most common in thoracic surgery since, in many cases, the lung function may be impaired already. After thoracic surgery the highest incidence is probably in abdominal operations, particularly those that requires a supraumblical incision.
Postoperative respiratory complications are due to retained secretions and/or decreased thoracic expansion due to pain. Sometimes these secretions are stringy and viscid and therefore difficult to expectorate. Following operation the patient is drowsy, making deep breathing and coughing difficult, and if the incision is thoracic or abdominal, coughing is voluntarily inhibited through fear of pain. Provided the patient is reassured that his stitches will not break through coughing, and his pain relieved by adequate analgesia, a good effective cough will clear these secretions. Postoperative analgesic make the patient lethargic and the presence of drains, intravenous lines or other tubes may make him relatively immobile and less likely to be able to clear his chest of secretions. Retained secretions may lead to the problems such as atelectasis or postoperative pulmonary collapse, postoperative pneumonia or aspiration pneumonia. The aim of pre and post operation physiotherapy is to prevent complications ( Downie 1985).
It has been well established that pulmonary function decreases following open-heart surgery (Taggart et al 1993, Van Belle et al 1992, Vargas et al 1992). General anesthesia has been shown to reduce functional residual capacity (FRC) by approximately 20%, cardiopulmonary bypass impairs gas exchange, and cardiac surgery patients with mammary arteries harvested have been shown to have a higher risk of pleural effusion and subsequent pulmonary problems (Matthay et al 1989). The incidence of alelectasis increases with each of general anesthesia; cardiopulmonary bypass and cardiac surgery (Matthay 1989) and atelectasis itself can result in decrease in FRC, vital capacity and lung compliance (Weiman et al 1993). As a result, patients undergoing cardiac surgery are at risk of developing postoperative pulmonary complications. There is three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, co morbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (Pereira 1999).
The physiotherapist must consider the general condition of the patient and must remember the possible feelings