Yoga breathing and respiratory complications in surgical patients

Patients planned for elective abdominal surgery (laparoscopy or laparotomy) were required to attend preoperative evaluation by anesthesiologist in outpatient clinic approximately a week before surgery. Patients who were eligible for the study were given oral and written instructions about breathing exercise performance. The participants in subject group should start the exercises in preoperative period (during 5 to 7 days) and continue it during the 5 postoperative days. Expected duration of each breathing session is 7 minutes. The subject group performed yoga breathing exercises-pranayama, consisting of seven consecutive cycles of alternate nasal breathing. Each cycle begins with deep inhalation through left nostril, preceded by deep exhalation. After holding the breath for few seconds, exhalation through right nostril takes place followed by inhalation through right nostril and exhalation through left nostril. Upon exhalation through left nostril, the breathing cycle is completed and the next one takes place immediately by inspiration through left nostril. The participants should performed seven breathing cycles once a day for 5 consecutive preoperative and postoperative days. Deep and slow breathing is recommended. Participants are instructed to stop the breathing exercises if any kind of discomfort occurs (dizziness, nausea, unpleasant feeling of dyspnea etc). It will be noted in medical record. Airflow through nostrils is regulated by right hand. During inhalation through left nostril, the right one is closed by right thumb. The ring finger of right hand is used to close the left nostril, while exhalation is performed through the right one. Peak expiratory flow (PEF) is assessed along with partial pressure of oxygen (paO2), paCO2 (partial pressure of carbon dioxide) and SaO2(saturation of arterial blood by oxygen) measured via arterial blood gas sample in preoperatively. Neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin are part of routine preoperative laboratory evaluation before major abdominal surgery and data is available in medical record. ARISCAT score was calculated for each patient which was based on seven independent risk factors for PPC: preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age of the patient, preoperative hemoglobin levels, site of surgery, duration of surgery, and emergency surgery. Adherence to above mentioned protocol will be checked by written questionnaire that will be given to patients at the end of the fifth postoperative day.