British Journal of Anaesthesia, 2003, Vol. 91, No. 1 61-72
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Review Article |
New concepts of atelectasis during general anaesthesia
Department of Anaesthesiology, University Hospital, CHUV, CH-1011 Lausanne, Switzerland
Corresponding author. E-mail: lennart.magnusson@chuv.hospvd.ch
Keywords: anaesthetic techniques; complications, atelectasis; lung, atelectasis; measurement techniques, tomography
| The first 150 words of the full text of this article appear below. |
At the beginning of the last century, Pasteur described postoperative pulmonary atelectasis,58 analysed postoperative pulmonary complications (PCC; see below) and noted: ‘when the true history of postoperative lung complications comes to be written, active collapse of the lung, from deficiency of inspiratory power, will be found to occupy an important position among determining causes’.59 Indeed, atelectasis occurs regularly during general anaesthesia induction,46 persists postoperatively44 and may contribute to significant morbidity7 8 and additional healthcare costs.43
This review article will review the mechanism of perioperative atelectasis, discuss its clinical significance and describe preventive measures.
Gas exchange and general anaesthesia
In 1964, Nunn56 showed that during routine anaesthesia and spontaneous ventilation, gas exchange was altered by shunt and uneven ventilation perfusion ratios. He concluded that to ensure the maintenance of a normal arterial PO2, the alveolar PO2 had to be as high as 200 mm Hg and this required an inspired oxygen concentration (F
Atelectasis and general anaesthesia
Measurement of atelectasis
Causes of atelectasis formation during general anaesthesia
Compression atelectasis
Absorption atelectasis
Loss-of-surfactant atelectasis
Factors influencing atelectasis formation
Fraction of inspired oxygen
Obesity
Chronic obstructive pulmonary disease
Other factors
Importance of atelectasis on patient outcome
Perioperative hypoxaemia
Hypoxaemia during induction of anaesthesia
Hypoxaemia during awakening and in the PACU
Postoperative pulmonary complications
Prevention of atelectasis formation
Conclusion
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