The issue of air travel following surgical intervention is becoming an increasingly important issue with the wider use of day surgery.
It should be kept in mind that post-operative patients are in a state of increased oxygen consumption due to the trauma of surgery, the increased adrenergic outflow and the possible presence of sepsis.
Concurrently, oxygen levels may be decreased or fixed in patients who are:
- volume depleted
- anaemic or who have cardiopulmonary disease
Consequently, for such patients it would be wise to delay air travel for several days or request oxygen to be provided. With the decreased use of blood transfusion, many post-operative patients are more anaemic than they have been in the past. It is not uncommon to see young patients with haemoglobins of the order of 7 g/dl and elderly patients with haemoglobins of approximately 8 g/dl (see also our information concerning Haematological Disorders).
It is important to remember that intestinal gas will expand by approximately 30% by volume at a cabin altitude of 8,000 feet. Many post-abdominal surgery patients have a relative ileus for some days, thereby putting them at risk of tearing suture lines, bleeding or indeed, in extreme circumstances perforation. Stretching intestinal or gastric mucosa may also result in haemorrhage.
To avoid such complications, travel should be avoided for 10 days following abdominal surgery. Following other procedures, such as colonoscopy where a large amount of gas has been introduced into the colon, it is advisable to avoid travel by air for 24 hours. Similarly, it is advisable to avoid flying for approximately 24 hours after laparoscopic intervention, due to the residual CO2 gas, which may be in the intra-abdominal cavity.
Neurosurgical intervention may leave gas trapped within the skull, which again may expand at altitude. It is therefore advisable to avoid air travel for approximately 7 days following this type of procedure.
Ophthalmological procedures for retinal detachment also involve the introduction of gas by intra-ocular injections, which temporarily increase intra-ocular pressure. Depending on the gas, it may be necessary to delay travel for approximately 2 weeks if sulphur hexafluoride is used and 6 weeks with the use of perfluoropropane. For other intra-ocular procedure and penetrating eye injuries, 1 week should elapse before flying.
Passengers who have experienced traumatic injuries within 7 days prior to travel, including from falls or accidents of any nature, should contact their airline to determine their suitability to travel. This is particularly important with injuries affecting the chest, as these may cause cardio-respiratory decompensation at altitude.
Following the application of a plaster cast, the majority of airlines restrict flying for 24 hours on flights of less than 2 hours or 48 hours for longer flights. This is principally due to the risk of circulatory impairment as a result of tissue swelling, particularly in lower limb injuries if the leg cannot be elevated during travel. If there is an urgent need for travel before these limits, the plaster cast may be bivalved. If a pneumatic splint is used, some air should be released to allow for gaseous expansion at altitude, which could cause discomfort as well as potential circulatory compromise or neuropraxia.