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Preventing Lung Problems After Surgery and General Anesthesia

Lung problems are not uncommon after surgery. The anesthesia medications used during surgery can affect how well our lungs work immediately after surgery. Also, inactivity after surgery (secondary to pain, drowsiness) limits 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. The breaths you take are not as deep as you normally take when you are up and active. These shallower breaths keep some of the tiny air sacs in your lungs (called alveoli) from fully filling with air. As a result of this, these sacs can flatten. Additionally, following surgery, inactivity, pain, and the side effects of pain medications, can further contribute to this slowed, shallow breathing. This is particularly common after abdominal or chest surgery.

The collapse of these air sacs following surgery is one cause of atelectasis, which is a common minor complication seen in patients undergoing general anesthesia. Atelectasis, if more severe, can lead to hypoxia (decreased oxygenation). Atelectasis can also cause fever. If you not appropriately addressed, atelectasis can lead to complications like pneumonia or even respiratory failure.

In order to get air back into these sacs and open them up, you need to take deep breaths and hold them.  Deep breathing exercises have other benefits too. They can help you to relax and assist with post-operative pain control.

If you’re in too much pain to take deep breaths, let your doctor or nurse know so that your pain can be better controlled. 

Anatomy of the Lungs

AlveoliYour airway is structured like an upside down tree. When you breathe in, the air flows into the trunk-like trachea which then divides into two large branch-like bronchi. Within each lung, these bronchi further divide into progressively smaller branches. The smallest of these branches are known as the respiratory bronchioles.  Attached to the respiratory bronchiole are a cluster of grape-like structures called alveoli. Alveoli are grape or balloon-like air sacs (each air sac is known as an alveolus). There are about 300 million alveoli in each lung.  These tiny sacs have thin walls lines by tiny blood vessels called capillaries that allow for the exchange of gases between the air we breathe and our blood. Oxygen from the air is absorbed and carbon dioxide in our blood is breathed out by the lungs. 

Breathing and Coughing Exercises

Practicing breathing and coughing exercises before your surgery will make it easier to do them afterwards. Again, this is particularly beneficial if you are undergoing general anesthesia. You’ll be less likely to have lung or breathing problems. If you are undergoing abdominal or chest surgery or have a history of lung problems, these exercises are even more important for your healthy recovery. 

Breathing Exercises

Diaphragmatic Breathing (deep breathing)

The green line is your diaphragm. Notice how the chest cavity expands when the diaphragm contracts (flattens). This occurs when you breathe in. 

After surgery, breathing exercises are an important part of the recovery. Doing these exercises will help prevent lung problems such as pneumonia. 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 chest cavity and the lungs expand when your diaphragm contracts. The diaphragm is a thin muscle located between your chest and abdominal cavities.  The purpose of deep breathing is to completely fill your lungs with air. In order to accomplish this, you need to use your other chest and abdominal muscles to help your diaphragm maximally expand your chest cavity. During this type of breathing, you should feel your lungs really expand and should even feel your abdomen expanding:

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

Coughing helps to 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 steps 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 you are awake.

Incentive spirometer

Incentive spirometerMany times, after surgery, you will be given an incentive spirometer (image right) to help you to do deep breathing exercises after surgery. The hospital staff will teach you how to use it. 

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 described prior.

After surgery, probably one of the best things you can do for your lungs is to walk. Once you’re walking sufficiently well, you typically don’t need to continue with the breathing exercises (unless otherwise directed by your health care professional).

If You Smoke

Nicotine (which is present in any tobacco product) has been proven to interfere with both the healing and recovery processes. In order to heal your wounds after surgery, your body relies on good blood flow to get the appropriate nutrition, etc. to your wounds. Nicotine actually causes your blood vessels to constrict, which limits the blood flow to areas where it is much needed. Furthermore, smoking is independently associated with chronic lung disease, heart issues, and blood vessel issues. Smoking has been shown to raise the risk of heart attack, stroke, lung complications, and wound issues following surgery. So avoiding smoking and other tobacco products around surgery is beneficial. 

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. Nicotine replacement products, contain nicotine, which again can interfere with blood flow and the healing process. 

Other Considerations 

When You Want to Know More

Want to Know More?

Our upper body (trunk) is divided into two main cavities: the thoracic (chest) cavity and the abdominal cavity. As mentioned previously, these cavities change shape as you breathe. The chest or thoracic cavity changes volumes as you breathe (via the diaphragm.- the breathing muscle).  The abdominal cavity can also change shape depending on its volume—for instance, based on how much you eat or drink. As the abdominal cavity expands, it begins to push up on the diaphragm. This is why it can be harder to breathe after a large meal. Additionally, when the abdomen pushes up on the thoracic cavity, the volume of the thoracic cavity actually gets smaller as well. 

Understanding this relationship can help you understand why it is particularly painful for you to take deep breaths after abdominal surgery. When you take deep breaths, the diaphragm pushes down on the abdominal cavity, pressing on tissues “injured” during surgery causing pain. It is important to remember that this is normal. You must still continue to take deep breaths for the reasons mentioned above. Maintaining a more erect posture can give your abdomen more room to bulge and make breathing a little bit less painful. 

Note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.

Comments

  1. My Dad recently had a surgery(18 days before) to remove an unwanted mass which is located near to chest and heart. After the surgery doctors have taken a CT and identified right side lung was in compress state and they referred to a pulmonologist and had a check up done and said everything is fine and asked to continue spirometer and breathing exercises. My Dad went for a follow up visit on y’day but doctors haven’t taken any xray to check whether the right side lung is okay now or not. We have communicated about this issue to doctors and they said he will recover slowly and no need to worry about it. Can anyone please let me know whether do we have to consult chest physician immediately or not?

  2. Harry Oscar says

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  3. Buddy Davis says

    I had a Desmoid Tumor removed from the right side of my neck that was 6cm and it was attached to my spine as well. After my surgery to remove the tumor I found that I couldn’t breath very easy and was givin a little plastic breathing thing to exercise my lungs which I did not do and now three or four weeks later I am wishing I would have.
    I will now start my breathing exercise and see if i can recover from my breathing problem.
    Wish me luck.

  4. I had asthma as a kid/young adult but have not experienced symptoms in a handful of years. I attributed the break to a change in diet – I eliminated milk and generally eat more fruits/veggies/less processed stuff. My guess is that my immune system was reacting to dairy and after being allowed to repair itself, I no longer experienced wheezing or chest tightness. In the last two months, I have had three surgeries and have been experiencing a re-occurance of my asthma symptoms. My guess is that all the anesthesia drugs and post-operative meds I was on did a number on my gut and now my immune system is reactive again. No surprise – none of my anesthesiologists or my surgeon seemed to have any idea or concern about why this was happening. Any thoughts?

  5. Wyatt Hunter says

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  6. Jackie Wallace says

    I wake up from general anesthesia gasping for air. They give me breathing treatments, but doesn’t seem to help. I’m getting ready for surgery again and I’m really scared about waking up like this as before. What can I do?

  7. Very good info. I had my gallbladder removed (laparoscopic) and when I tried to take a decent sized breath I was experiencing pain (likely from the surgery and still healing). Buy day three post-op I was still having trouble, feeling winded when I tried to talk more than a couple sentences and hoarseness. I was beginning to think something may be wrong so I went researching post-op breathing problems and ended up here. The surgery center mentioned I may need to do some deep breathing exercises and this was right along those lines. After just a few times I could tell a difference and now (5 days post-op) I feel much better. I never coughed anything up, but I could tell I was stretching things back out. Take it slow but yes please move toward breathing exercises. Talk to your doctor about it, always ask.

  8. I had kidney surgery in 1998 and was given only minimal pain reliever post-op for 2 days. On day 3 I developed a fever and pneumonia from only one reason, from breathing in only a shallow manner the previous 2 days (to avoid the pain associated with breathing). At the time fortunately it was a very knowledgeable doctor. He brought in to the room an incentive spirometer, which I still have to this day, and they provided a good clear description of why I needed to start using it on day 3, and good clear instructions on how to use it.

    They also started proper pain meds and told me I also had to get up and start walking around (since it was almost day 4 at that point). So at some point a person has to get up and move around too (when it’s the right time). Too little rest is bad and too much rest is bad as related to recovery.

    The reason I’m writing this message is I still have the incentive spirometer it is in clean like-new condition and I’m researching online if it could possibly help if or when a person gets the regular flu OR Covid-19. So far there’s mixed opinions online. I’m looking for consensus and also detail. When I see someone make abstract statements with no explanation and no detail, that kind of generalization is not trustworthy. When a person knows what they’re talking about, there will at least be a good amount of detail involved.

    Shallow breathing is not generally good because the small alveoli sacs do not get opened up properly. I am personally a little too sensitive to pain so I’m finding in my research that yes anything that can help a person take improved more-than-shallow inhale breaths is a good thing. For some people just temporarily accepting the discomfort and pain of taking regular inhale deep breaths (or close to it) can help them recover. Any “incentive” therefore to take more than just a shallow breath can help improve a general recovery time in my opinion.

    I have reviewed at least 20 online articles so far trying to find out if an incentive spirometer can help a recovery time if pneumonia has just started, and the answer is yes possibly, if the person’s immune system is working normally. And that is because the OPPOSITE (breathing shallowly) is BAD and causes the small alveoli sacs, which are filling with fluid to some degree with pneumonia, to not open up.

    I am not a doctor and this message is just personal testimony. Be sure to speak with a dr. about your health. If it has been awhile and you can’t cope and can’t breath properly then you should talk with a doctor you should ask for help. The spiritual side of health is also important so remember to pray and trust God. God loves you.

  9. Chyresse Nicholson says

    I recently had reconstructive surgery on my breasts and abdominal area (diep flap). This is the third time that I experienced extremely low O2 saturation for 2 days following surgery. I could barely stay awake and when I fell asleep my O2 would dip to 86. They put me on high levels of oxygen and moved me to ICU for observation. No pain, cough, or shortness of breath. No blood clots. They advised no additional surgery except in an emergency because I could end up on a ventilator. What gives? My pulmonary doctor had no explanation. Was it the type or amount of anesthesia?

  10. I just had surgery on my broken ankle. Ever since been having breathing problems. I kept complaining that I couldn’t breath. Was told your getting plenty of oxygen was having side effects from the anesthesia and it took 24 to 48 hrs to get out of my system. Well it’s been about a week and still was having trouble. I found this site and did the breathing and coughing exercises and it worked. Now I’m breathing much better. It’s like my lung muscles were kinda paralyzed and weren’t working right. But now I feel like the exercises jump started them again. So glad I found this. It was scary not being to breath right.

  11. Kristi Hawk says

    I had a right knee arthroscopy and my diaphragm is really sore and my throat is still sore. When I cough my diaphragm hurts….

  12. Maheshbabu says

    My wife got decartication of lungs infected with Hydatid cyst ,10days after surgery Dr insisted for one more surgery saying her lungs not getting fully expanding
    She has got an opening at chest with one pipe to help her to breath
    She is doing respirimeter exercise
    Whether this breathing exercise will help her to recover ? I non’t want her to have one more surgery

  13. lucy rodriguez says

    I had gallbladder surgery friday today is sunday ,is it normal to not have congestion ,I’ve been trying to cough up stuff but nothing comes out ,is it possible I dnt have any congestion in my.lungs

  14. lucy rodriguez says

    Great information so happy I found it ,I had gallbladder surgery friday today is sunday ,I’ve been doing the breathing with the trying to cough, is it normal that im not coughing up anything

  15. Fred I don’t know any answers to your questions but wanted to let you know I’ll certainly be praying for you.
    I had surgery Wednesday and came home yesterday and have been having trouble getting my breath. I told them that in the hospital but they kind of ignored it. Said my oxygen sat was 98 percent and I was fine. Maybe so but I feel like a fish out of water 🙁
    I’m going to do the exercises I found on this site and hopefully it will help.

  16. Fred Strout says

    I am getting ready to have major surgery for a bladder diversion and Urostomy and to fix one of my ureters. I will be under heavy sedation for 4-5hrs I am really concern that I will develop pneumonia because this is a high risk surgery, I am 70yrs old, have COPD (never smoked) , CHF and just got over double pneumonia 2 months ago. The surgery must be done with out a doubt. Anyone have any 💡 whether I should be that concern. My surgery is on 8/2 so anyone who would consider praying 🙏 for me I would appreciate it. Sincerely Yours! Fred S

  17. Wow! I’m glad I came across this site. I’ve been having respiratory difficulty since my parathyroidectomy surgery. I was dosed twice with a general anesthetic due to an ill-placed IV. The first dose went into my tissues, and not my vein. After a week of nausea and extreme drowsiness, I am unable to expend any energy without becoming breathless. Even though I have expressed this to all (PC, ENT, endocrinology) professionals involved in my health care, no one has expressed an interest in helping me alleviate the problem. So glad I have the internet to do my own research. It has been beneficial to me on more than one occasion.
    Thank you so much for posting this helpful, life-enhancing information!

  18. hi I had clavicle fixation 2 months ago then I am experiencing breathing difficulties

    this is stressing me
    please advice

  19. I had surgery today and the first one one month ago. I’m below average in this area, in that I’m told I take one hour longer than the average out patient. I couldn’t suck a straw and thought my grandma on oxygen must feel like this. I realized recently after a genetics test that I may have had mild asthma that improved after mountain life, but returns now and then and I thought bronchitis and allergies or stress triggering were triggers and so not asthma and thus was normal for everyone. It’s not nearly as bad as childhood when I thought everyone else breathed like this until I was 18 after moving higher and from the polluted city. Does it effect recovery time? I don’t use an inhaler, but have been given one before when I had bronchitis. They gave me one of those masks with oxygen blowing on my face. It felt great and I wandered is this how I’m supposed to feel. Any other experiences of those with slight asthma and longer recovery time or who used to get bronchitis of ammonia in childhood. I wandered if it was because I don’t work as hard as the others at breathing. I couldn’t suck a straw for two hours, but had a yogurt drink and worked at it. I gave up sucking on the straw in the hospital and drank from the side instead even if I dribbled water down the side. They sat me up in a chair and said that helped.

  20. Peter Davis says

    Just recovering from pneumonia my physio gave me a latex glove on the end of a lollipop stick to inflate. It did work for a while, but then there was a loud bang as the glove gave out. I was a little concerned so I closed my eyes for health and safety. But it did really help the increase in pressure in my lungs.
    I’m still trying to find a proper replacement, can find gadgets that help you in hail but nothing to help increase the pressure when you blow out. I will keep looking.

  21. Joanne Rowland says

    Ive had a tummy tuck and leg and thigh lift …after the leg and thigh lift ive developed bad breathing wheezing and coughing also im sick a white and yellow phlem …this is happening on and off all dsy and night and is very frightening for myself and people around me …im.now over 10 weeks post op and im getting no better worse if anything im doing my breathing excercises all the time ..
    Any advice please im desperate

  22. I had sinus surgery Friday (today is Sunday). My diaphragm hurts like a muscle ache. Not necessarily to breathe, but to move, cough, or sneeze (which I have sneezed 12 times today). I have these breathing
    and coughing exercising with high hope this pain will go away.

  23. Stephen Buckley says

    I’ve had a kidney transplant surgery about 3 months ago and I am finding this out now. The difficulty of acquiring a deep breath (and an elevated blood pressure) I assumed was from the compromised abdomen from the incision area on the lower pelvis. I figured after atleast two months when I could finally stretch and do some exercises that this feeling would improve. I wasn’t dedicated to much of the breathing exercises mentioned due to some extreme edema at the time. Is this something that will improve over time with activity?

  24. Kristina says

    I had ankle surgery 5 days ago, and had low oxygen levels in hospital after surgery. They put me on a monitor and found my o2 readings getting as low as 68. At one point they had me on liters of oxygen.

    I was released yesterday, still concerned about this, I have crackles in my lungs while breathing, and am having trouble breathing again.

    I startled awake from extremely loud snores. I’m not bed ridden, but being on crutches is agony, so I’m lying down most of the time.

    I suffered from urine retention, when that finally went away I was up constantly going to the bathroom.

    First night in the hospital I barely slept because I would doze off and wake up not breathing.

    I may go to the hospital later because of this.

  25. Very informative and relaxed me a little,it was scary before I did the exercises. Would have been helpful to know before surgery! I was afraid to go to sleep ?

  26. Experienced severe lung buring for 2 days after general anesthesia for a cardiac ablation no one seems to have an explanation i do have asthma that is well controlled

  27. Brian McDermott says

    As a medical investigator with an extensive background in healthcare, with a wife who is a clinical care provider, you would think we could know when a healthcare team is truly of quality — competent in giving patients all need to know information and instructions as noted above both prior to and after sinus surgery, which my wife recently underwent — but truth is, assessing in advance what quality of care shall be provided is a very difficult challenge. Trust in providers as the experts they are is a double edged sword. It’s scary, the majority of comments above mirror our own experience of not having been given this knowledge prior to surgery, and now my wife suffering severe acute bronchitis and not even diagnosed as such! We ourselves diagnosed it using our medical knowledge and training coupled with online resources, which then led the doctors to diagnose it. The point is simple: hospitals/ surgical centers and physicians including surgeons, anesthesiologists, attending MDs, nurse practitioners and others on the care team, are rarely attentive to the details they are assumed to be attentive to, such as these simple preventive measures pre-op. The advice I give is to never trust blindly any care provider. Research extensively prior to agreeing to any procedure or treatment course. Get 2nd opinions. Postop, If you suspect negligence, odds are good you are correct. Medical errors are the 3rd leading cause of death. It’s a fact that this website offers extensive knowledge and accurate guidance; it may be relied upon; and is often if not always a better source of medical knowledge for your specific case than what your $1200/ hour physician provides. This is not a paid “promotion” this is a professional speaking candidly about a very important matter — your wellbeing, health, and life. I am now investigating the “care providers” for having failed to give what is very simple advisory such as this. It’s shocking yet not surprising nearly all persons posting comments have the very same experience. It is not easy asking your providers the tough questions and informing them of what YOU KNOW, and literally overseeing the care they provide, not trusting them to do it perfectly well on your behalf. Most are not accustomed to having informed, activated patients. But they should, now more than ever. And any doctor who is insecure about it is a doctor to replace. Remember: doctors are paid to work for YOU, not solely paid to play doctor irrelevant of your personal health needs.

  28. I am going to ask before having breast reduction surgery if they will put me on oxygen after.

  29. This was so helpful! Thank you for sharing.
    I wish the hospital that just removed a simple cyst from my wrist under general anesthesia would have made mention of ANYTHING related to possible breathing complications in all their info they print/send home with a person!!
    2nd day after procedure, I began weezing. Found this information and within hours was feeling so much better.

  30. I had a simple colonoscopy under a twilight anesthetic and found myself coughing uncontrollably upon waking up. Before being discharged I asked if wheezing and coughing was normal? The nurse gave a breathing treatment to me and I seemed ok for awhile. Next thing I knew I was headed to the ER unable to breath, but this time I felt my blood pressure was high and felt faint. Now I’m on a steroid, inhaler and antibiotics…I have never had this happen so it can happen to you! Apparently when you are so relaxed under anesthetic, your saliva can fall back into the lungs and cause this issue.

  31. Sarah Adams says

    How long does it usually take to get rid of the pain in your lungs? I discover these breathing exercises last night about 3 hrs before going to sleep. This morning the the pain was the worse so far(2 days after surgery), how long does it usually take for the pain to subside, and when should I call the doctor?

  32. Susan Worner says

    This was very helpful! Had general anesthesia for minor vascular surgery, and started developing rapid accumulation of clear fluid on the lungs on day 3 post-op. I just did the breathing and coughing exercises and it is helping already. The sad thing is, my pre-op nurse apparently didn’t know the purpose of the incentive spirometer. She said it was for people who might have trouble remembering to breathe after surgery, and quickly put it away– almost laughing, as if sure I wouldn’t need it.

  33. 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.

  34. 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!!

  35. 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,

  36. 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.

  37. 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.

  38. 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

  39. 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!

  40. Very useful information and well explained . Thank you

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