BJA Advance Access originally published online on February 27, 2007
British Journal of Anaesthesia 2007 98(4):503-508; doi:10.1093/bja/aem002
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Impact of depth of propofol anaesthesia on functional residual capacity and ventilation distribution in healthy preschool children
1 Division of Anaesthesia
2 Division of Pulmonology and Intensive Care, University of Basel Children's Hospital, Roemergasse 8, CH-4005 Basel, Switzerland
3 Division of Paediatric Intensive Care, Mater Misericordiae Hospital, South Brisbane, QLD 4101, Australia
* Corresponding author: Division of Anaesthesia, University of Basel Children's Hospital, Roemergasse 8, CH-4005 Basel, Switzerland E-mail: bvonungern{at}uhbs.ch
Background: Propofol is commonly used in children undergoing diagnostic interventions under anaesthesia or deep sedation. Because hypoxaemia is the most common cause of critical deterioration during anaesthesia and sedation, improved understanding of the effects of anaesthetics on pulmonary function is essential. The aim of this study was to determine the effect of different levels of propofol anaesthesia on functional residual capacity (FRC) and ventilation distribution.
Methods: In 20 children without cardiopulmonary disease mean age (SD) 49.75 (13.3) months and mean weight (SD) 17.5 (3.9) kg, anaesthesia was induced by a bolus of i.v. propofol 2 mg kg–1 followed by an infusion of propofol 120 µg kg–1 min–1 (level I). Then, a bolus of propofol 1 mg kg–1 was given followed by a propofol infusion at 240 µg kg–1 min–1 (level II). FRC and lung clearance index (LCI) were calculated at each level of anaesthesia using multibreath analysis.
Results: The FRC mean (SD) decreased from 20.7 (3.3) ml kg–1 at anaesthesia level I to 17.7 (3.9) ml kg–1 at level II (P < 0.0001). At the same time, mean (SD) LCI increased from 10.4 (1.1) to 11.9 (2.2) (P = 0.0038), whereas bispectral index score values decreased from mean (SD) 57.5 (7.2) to 35.5 (5.9) (P < 0.0001).
Conclusions: Propofol elicited a deeper level of anaesthesia that led to a significant decrease of the FRC whereas at the same time the LCI, an index for ventilation distribution, increased indicating an increased vulnerability to hypoxaemia.
Keywords: anaesthetics i.v., propofol; anaesthesia, paediatric; lung, clearance index; respiratory function, functional residual capacity; sedation; ventilation, distribution; ventilation, homogeneity
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