British Journal of Anaesthesia, 1993, Vol. 71, No. 6 788-795
© 1993 The Board of Management and Trustees of the British Journal of Anaesthesia
research-article |
RE-EXPANSION OF ATELECTASIS DURING GENERAL ANAESTHESIA: A COMPUTED TOMOGRAPHY STUDY
Department of Anaesthesiology and Intensive Care, University Hospital S-751 85 Uppsala, Sweden
Department of Radiology, University Hospital S-751 85 Uppsala, Sweden
Department of Clinical Physiology, University Hospital S-751 85 Uppsala, Sweden
Formation of atelectasis is one mechanism of impaired gas exchange during general anaesthesia. We have studied manoeuvres to re-expand such atelectasis in 16 consecutive, anaesthetized adults with healthy lungs. In group 1 (10 patients), the lungs were inflated stepwise to an airway pressure (Paw) of 10, 20, 30 and 40 cm H2O In group 2 (six patients), three repeated inflations up to Paw = 30 cm H2O were followed by one inflation to 40 cm H2O. Atelectasis was assessed by analysis of computed x-ray tomography (CT). In group 1 the mean area of atelectasis in the CT scan at the level of the right diaphragm was 6.4 cm2 at Paw = 0 cm H2O, 5.9 cm2 at 20 cm H2O, 3.5 cm 2 at 30 cm H2O and 0.8 cm2 at 40 cm H2O, A Paw of 20 cm H2O corresponds approximately to inflation with twice the tidal volume. In group 2 the mean area of atelectasis was 9.0 cm2 at Paw = 0 cm H2O and 4.2 cm2 after the first inflation to 30 cm H2O. Repeated inflations did not add to re-expansion of atelectasis. The final inflation (Paw = 40 cm H2O) virtually eliminated the atelectasis. We conclude that, after induction of anaesthesia, the amount of atelectasis was not reduced by inflation of the lungs with a conventional tidal volume or with a double tidal volume ("sigh"). An inflation to vital capacity (Paw = 40 cm H2O, however, re-expanded virtually all atelectatic lung tissue. (Br. J. Anaesth. 1993; 71: 788–795)
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