Preventing Lung Problems After Surgery and General Anesthesia

Our bodies need oxygen to help us heal after surgery or an injury. Anesthesia used during surgery can affect how well our lungs work after surgery. Also, being inactive from surgery reduces the amount of oxygen taken in by our lungs since we don’t breath as deeply as we do when we are active, even just doing our daily activities.

There are many kinds of surgery done under general anesthesia. With general anesthesia, you are “put to sleep” and your breathing is slowed down and the breaths you take are not as deep as you normally take when you are up and active. These shallower breaths keep the tiny air sacs in your lungs (alveoli) from filling with air. These sacs can flatten and their insides stick together like a water balloon after you let the water out. In order to get air back into these sacs and open them up, you need to take deep breaths and hold them. Holding your breath makes the sides of the little air sacs pop apart and the sacs fill with air. If you don’t get the little air sacs (alveoli) filled with air you may have complications like pneumonia.

Deep breathing exercises can also help relax you and relieve pain. If you had chest or abdominal surgery, press a pillow firmly against your incision to reduce the discomfort from deep breathing and coughing. If you’re in too much pain to take deep breaths and cough, let your doctor or one of the nurses know so your pain can be better controlled and you can do the breathing exercises.

Anatomy of the Alveoli

AlveoliAlveolus is a group of ballonlike sacs at the end of a bronchiole. The bronchioles or bronchioli are the first passageways which takes in air from the nose or mouth to the air sacs (alveoli) of the lungs. These tiny sacs have capillaries in their thin walls and allow oxygen to be absorbed into the blood. Oxygen is breathed in and absorbed into the bloodstream by the capillaries in the thin walls of each alveolus. Carbon dioxide is carried from the capillaries in the alveolus to be breathed out by the lungs. There are about 300 million alveoli in each lung.

Breathing and Coughing Exercises

Practicing these breathing exercises before you have surgery will make it easier to do them afterward—and you’ll be less likely to have lung or breathing problems.If you know you are going to have general anesthesia, you can learn and practice breathing and coughing exercises before you go. If you had emergency surgery, be sure to do the breathing and coughing exercises after your surgery while you are on bed rest and are unable to get up and walk around. These exercises are particularly important if you had abdominal or chest surgery or your are prone to lung problems.

Breathing Exercises

Diaphragmatic Breathing (deep breathing)

The green line is your diaphragm

After you have surgery with general anesthesia you need to do breathing exercises. Doing these exercises will help prevent lung problems such as pneumonia and bronchitis. The breathing exercises include deep breathing and coughing. Learn and practice these exercises before surgery; practice everyday for at least a week before your surgery.

Deep Breathing (diaphragmatic breathing, abdominal breathing, belly breathing)

The purpose of deep breathing is to completely fill your lungs with air. Use your chest and stomach muscles to breathe the right way; done by contracting the diaphragm, a muscle located horizontally between the chest cavity and stomach cavity. Air enters the lungs and the belly expands during this type of breathing.
1. Breathe in through your nose as deeply as you can (your stomach should go out as you breathe in). Hold your breath for 5-7 seconds.
2. Let your breath out through your mouth slowly—take twice as long to breathe out as you did to breathe in. Purse your lips (like you’re blowing out a candle) as you breathe out. Your stomach should go out as you breathe out.

Do this exercise 10 times. After you do the deep breathing exercise, do the coughing exercise.


Coughing helps keep your lungs clear.
1. Take a slow, deep breath in through your nose. Try to fully expand your chest and back.
2. Breathe out through your mouth; you should feel your chest sink down and in.
3. Repeat 1. and 2. for a second breath.
4. Take a third breath, but instead of breathing out, hold your breath for a moment and then cough hard forcing the air out of your lungs.

Do the coughing exercise 3 times. Do the combined breathing and coughing exercises every hour while your awake.

Incentive spirometer

Incentive spirometerSome hospitals give out an incentive spirometer (image right) to help you do deep breathing exercises before and after surgery. Someone will show you how to use the incentive spirometer when you get it. If you’re given an incentive spirometer before surgery, don’t forget to bring it to the hospital with you when you come for surgery.

How to use the incentive spirometer

• Sit up as straight as you can. If you’re in a hospital bed, sit on the edge of your bed or raise the head of your bed so you’re sitting up straight.
• Hold the incentive spirometer in an upright position. (see picture above)
• Put the mouthpiece in your mouth and close your lips tightly around it forming a seal.
• Breathe in slowly and as deeply as you can to raise the piston in the air cylinder up to the top of the cylinder.
• Hold your breath as long as you can (at least 5 seconds), then let the piston fall to the bottom of the air cylinder.
• Rest for a few seconds and repeat the steps above at least 10 times every hour while you’re awake.
• After each set of 10 deep breaths, do the coughing exercise above to keep your lungs clear.

Once you’re able to get up and walk around, take some deep breaths and cough well as you walk. You may stop doing the breathing exercises or using the incentive spirometer once you’re up and around (unless your health care teams tells you to keep doing the exercises). If you’re unable to get up and move around at home, do your breathing exercises on the days you’re inactive.

If You Smoke

Nicotine slows down the healing and recovery process. Quitting smoking (or using any tobacco products) even a week before surgery can lower your risks of having surgery. Rather than have the stress of nicotine withdrawal while your body is recovering from surgery, try to quit smoking a few weeks before surgery. Talk with your surgeon before using nicotine replacement products such as a patch, gum, or cigarette substitute or to help you find ways to quit.

When You Want to Know More

When You Want to Know More

Want to Know More?

Our trunk is divided into two main cavities: thoracic cavity and the abdominal cavity. Both cavities are bound on the back by the spine. Even though their location is defined, the shape of these cavities can change. Breathing is the main way the shape of these two cavities changes. The abdominal cavity changes shape similar to a water-filled ballon. When you squeeze the balloon, the shape changes as the balloon bulges. When breathing compresses the abdominal cavity it “bulges” into a different shape. The abdominal cavity can also change shape based on volume—that is how much you eat and drink. The more you eat and drink, the harder it is for the diaphragm to compress the abdominal cavity—which is why it is harder to breathe after a large meal. Also, an increase in volume of the abdominal cavity decreases the volume in the thoracic cavity—you can take in less air. The thoracic cavity changes both shape and volume when you breathe. When you breathe out, the volume decreases; when you breathe in the volume increases. Because these two cavities are linked together by each changing the shape of the other, you can see that the quality of breathing affects the health of abdominal organs and the health of our organs affects the quality of our breathing.

Knowing how breathing changes the shape of the two cavities will help you understand why it may be painful for you to take deep breaths after high abdominal surgery. When you take a deep breath the diaphragm pushes down on the abdominal cavity, pressing on tissues “injured” during surgery causing pain. Even so, it is very important for you take deep breaths and bring in healing oxygen. Certain posture can help a lot in easing the pain while taking deep breaths by giving your abdomen room to “bulge.” Sit up as straight as you can when taking deep breaths. Take deep breaths whenever you are up and walking—stand as straight as you can when you are walking.

  • PugMom

    Wow. Great article. I had sinus surgery yesterday and was wheezing this morning and coughing a lot. Did these exercises and the wheezing is gone. Amazing. Now I know for future surgeries. However, given you could contract Pnuemonia, it is pretty upsetting that no one tells you to do this after surgery.

  • Felicia

    I had a bout with a respiratory virus that has been going around and discovered that these breathing exercises are helping me clear the congestion leftover from that! I knew that I had done breathing exercises after all of my surgeries but wasn’t sure it would help in my present situation, fortunately for me, it has! Great article!!

  • Larry

    I been having problem breathing my self I had surgery on 1996 and my doctor didn’t tell me about breathing exercise and im finding these too help about coughing and breathing exercise,
    im starting doing this, and hopefully it goes back too normal someday i’m glad I found this website here,

  • Howard

    I had a simple nasal polyps operation at London Hospital, White Chapel, UK. The anaethetist decided not to give me opiates in an attempt to prevent my history of vomitting after general anaesthetic. Bad mistake I awoke abrubtly from the ”general’ with a sharp stabbing pain in my left chest. Shock ensued. Breathing and coughing was not mentioned by anaethetist, surgeon or nurses at all to get lungs functioning.

  • Name

    I also agree. This is sad that we are not being told about this. My mom had surgery yesterday and is having a hard time breathing. Now I know why.

  • Lee

    I too had general anesthesia and didn’t know how important the coughing is. I coughed so hard I thought my ribs would crack. Now I know it is necessary to breathe and cough. Good article.
    cs in las vegas

  • Tomas

    I’ve had a knee arthroscopy with general anesthesia two days ago and was getting a bit worried about the uncomfort I was feeling when trying breathe in deeply. I’m not very happy that the hospital staff forgot to tell me about the post-op breathing exercises, but at least now I’ll start doing them and hopefully return to normal functioning soon. Thank you!

  • cjos

    Very useful information and well explained . Thank you