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Vol. 45. Issue 1.
Pages 30-35 (January 2009)
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Vol. 45. Issue 1.
Pages 30-35 (January 2009)
Original Article
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Modifications of Diaphragmatic Activity Induced by Midline Laparotomy and Changes in Abdominal Wall Compliance
Modificaciones en la actividad del diafragma inducidas por laparotomía media y cambios en la rigidez de la pared abdominal
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Joaquim Geaa,
Corresponding author
jgea@imim.es

Corresponding author.
, Juan Bautista Gáldizb,d, Norman Comtoisa, Ercheng Zhua, Igor Salazkina, José antonio Fiza,e, Alejandro Grassinoa,e
a Hôpital de Notre-Dame, Université de Montréal, Montréal, Québec, Canada
b Meakins-Christie Laboratories, McGill University, Montréal, Québec, Canada
d Servicio de Neumología, Hospital de Cruces, Barakaldo, Universidad del País Vasco, Vizcaya, Spain
e Servei de Pneumologia, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Introduction and Objective

Diaphragmatic activity varies with the initial length of the muscle. Our objective was to evaluate the influence of surgery and changes in abdominal wall compliance on diaphragmatic activity.

Methods

Both phrenic nerves in 7 mongrel dogs were stimulated electrically with single supramaximal pulses (twitch). The gastric (Pga) and transdiaphragmatic (Pdi) pressures generated and muscle shortening (sonomicrometry) were used to evaluate diaphragmatic activity, which was determined at baseline, after midline laparotomy, with an elastic abdominal bandage, and with a rigid circular cast. Abdominal pressure was then gradually increased in order to induce progressive lengthening of the diaphragm.

Results

After laparotomy, the pressures were somewhat lower (by 12%) than at baseline. The elastic bandage produced a slight increase in the pressure generated by the diaphragm (mean [SE] values: Pga, from 4.2 [0.3] cm H2O to 6.3 [0.9] cm H2O, P<.01; Pdi, from 12.1 [2.0] cm H2O to 15.4 [1.8] cm H2O, P<.05]), and these values increased even further with the rigid cast (Pga, to 12.6 [1.5] cm H2O; Pdi, to 20.2 [2.3] cm H2O; P<.01 for both comparisons); this occurred despite smaller degrees of muscle shortening: by 57% [5%] of the initial length at functional residual capacity at baseline, by 49% [5%] with the bandage (P<.05), and by 39% [6%] with the cast (P<.01). With progressive lengthening of the muscle, its contractile efficacy increased up to a certain point (105% of the length at functional residual capacity), after which it began to decline.

Conclusions

Abdominal wall compliance plays an important role in the diaphragmatic response to stimulation. This appears to be due mainly to changes in its length at rest.

Keywords:
Diaphragm
Abdominal surgery
Abdominal cast
Muscle length
Resumen
Introducción y objetivos

La actividad del diafragma puede verse modificada por su longitud inicial. Nuestro objetivo ha sido evaluar la influencia de la cirugía y los cambios en la rigidez de la pared abdominal sobre la actividad del músculo.

Método

En 7 perros mestizos se estimularon eléctricamente ambos nervios frénicos con pulsos únicos supramáximos (twitch). Para evaluar la actividad del diafragma se determinaron las presiones generadas - gástrica (Pgatw) y transdiafragmática (Pditw)– y el acortamiento muscular (sonomicrometría). La respuesta diafragmática se obtuvo en situación basal, tras laparotomía media, con venda abdominal elástica y con prótesis rígida circular. A continuación se incrementó ligera y progresivamente la presión abdominal para conseguir el alargamiento sucesivo del diafragma.

Resultados

Tras la laparotomía, las presiones fueron algo inferiores a las basales (12%). La banda elástica provocó un leve aumento de la presión generada por el diafragma (valores medios ± error estándar. Pgatw: 4,2 ± 0,3 a 6,3 ± 0,9 cmH2O, p < 0,01; Pditw: 12,1 ± 2,0 a 15,4 ± 1,8 cm H2O, p < 0,05), que se incrementó aún más con la prótesis rígida (Pga=: 12,6 ± 1,5 cmH2O; Pditw: 20,2 ± 2,3 cmH2O; p < 0,01 para ambas), a pesar de valores de acortamiento inferiores -un 57 ± 5% de la longitud inicial a capacidad funcional residual en situación basal, un 49 ± 5% con banda (p < 0,05) y un 39 ± 6% con prótesis (p < 0,01)–. Al alargar progresivamente el músculo, su efectividad contráctil aumentó hasta un punto (un 105% de la longitud a capacidad funcional residual) a partir del cual comenzó a declinar.

Conclusión

La rigidez de la pared abdominal desempeña un papel importante en la respuesta del diafragma a la estimulación. Esto parece deberse fundamentalmente a cambios en su longitud de reposo.

Palabras clave:
Diafragma
Cirugía abdominal
Prótesis abdominal
Longitud muscular
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