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BJA Advance Access published online on January 23, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aem376
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Fentanyl decreases end-expiratory lung volume in patients anaesthetized with sevoflurane

G. Chawla and G. B. Drummond*

University Department of Anaesthesia, Critical Care, and Pain Medicine, 51 Little France Crescent, Edinburgh EH16 4SA, UK

* Corresponding author. E-mail: g.b.drummond{at}ed.ac.uk

Background: In patients breathing spontaneously during anaesthesia, expiratory muscle activity can be a prominent feature. This activity is triggered or exaggerated by opioid administration, which causes a prompt increase in intra-abdominal pressure. The effect of this increased expiratory activity on end-expiratory lung volume is not described.

Methods: Nine patients having minor gynaecological procedures were studied during stable anaesthetic conditions, breathing sevoflurane (end tidal 2.6%) through a laryngeal mask airway, in a circle system. The spill valve was closed and the fresh gas flow was temporarily reduced to approximate the oxygen uptake. The volume of the reservoir bag was then measured by placing it in a hinged, wedge-shaped container. Fentanyl (0.5 µg kg–1 ideal body weight) was given after 1 min of stable recording, and the change in end-expiratory volume measured after 3 min.

Results: End-expiratory lung volume decreased in all patients by 160 (111) ml (mean, SD) (P<0.01). The decrease did not relate to obesity.

Conclusions: During sevoflurane anaesthesia, fentanyl causes a rapid reduction in functional residual capacity. This is caused by increased activity of expiratory muscles and an increase in intra-abdominal pressure.

Keywords: anaesthetics volatile, sevoflurane; analgesics opioid, fentanyl; lung, volume; ventilation, analgesics, effects; ventilation, muscle, respiratory


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