Shortness of breath after surgery can be very scary and, in some cases, life-threatening. It may include such sensations as feeling unable to take a big breath, tightness in the chest or difficulty breathing. Shortness of breath can have numerous causes, including a blockage in the airway or atelectasis, a blood clot or fluid accumulation in the lungs. Feeling short of breath after surgery should never be ignored.

Airway Blockage

Blockage, or narrowing, may occur anywhere in the airway from the mouth to the lungs. After surgery, the mouth, tongue, vocal cords and throat can swell or muscles in these areas can go into spasm, causing narrowing of the airway and difficulty getting air into the lungs. After neck surgery, blood may collect to form a hematoma, which may press on the throat and cause collapse of the airway. Occasionally a blood clot enters the airway, causing blockage. This is most likely to occur after surgery involving the nose or airway.

Atelectasis and Lung Infection

Sometimes areas of the lung do not open fully when a person breathes in. This is called atelectasis 5. It is a very common cause of shortness of breath after surgery. Atelectasis can occur for a variety of reasons, including the effects of general anesthesia or being able to take only small breaths because of pain after chest or abdominal surgery. Smokers and people with lung disease often have trouble clearing mucus from their lungs after surgery, resulting in atelectasis. They may have excessive coughing as well as difficulty breathing. Fever and rapid breathing in addition to shortness of breath may indicate the presence of a lung infection, such as pneumonia.

Blood Clots and Heart or Fluid Problems

A blood clot may develop in a leg vein, especially after major surgery if a person is inactive. Sometimes the clot breaks off and travels to the chest, blocking blood flow to the lungs. This clot -- called a pulmonary embolus -- can produce shortness of breath, chest pain and a bloody cough. A heart attack, which is most likely to occur in people with preexisting heart disease, can also cause difficulty breathing. Crushing chest pain, lightheadedness, palpitations and nausea may or may not be present as well.

Intravenous fluids administered during surgery sometimes accumulate in the lungs, causing difficulty breathing. This is especially likely after major surgery when large amounts of fluid are received. It is also more common in people with heart failure, whose heart muscle is unable to pump the extra amount of fluid in the blood so the fluid backs up into the lungs.

Other Causes

Severe blood loss from major surgery may cause anemia, reducing the number of red blood cells so there are not enough to carry oxygen throughout the body. This can lead to shortness of breath as the body tries to breathe in more oxygen. Sometimes shortness of breath is due to air accumulating in the space surrounding the lung, causing compression and collapse of the lung. This air accumulation, called a pneumothorax, is particularly likely after chest surgery or after the insertion of a central line -- an intravenous tube in a large chest or neck vein.

Warnings

As some causes of shortness of breath after surgery are potentially life-threatening, always report any difficulty breathing after an operation to your doctor. Also seek prompt medical attention if you notice a painful or swollen calf, as this may indicate a blood clot in the leg, which could lead to a pulmonary embolus.

Reviewed by: Mary D. Daley, MD

The Wrap Up

Atelectasis can occur for a variety of reasons, including the effects of general anesthesia or being able to take only small breaths because of pain after chest or abdominal surgery. Smokers and people with lung disease often have trouble clearing mucus from their lungs after surgery, resulting in atelectasis. It is also more common in people with heart failure, whose heart muscle is unable to pump the extra amount of fluid in the blood so the fluid backs up into the lungs.

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