Atelectasis during anaesthesia and in the postoperative period

Abstract

Transverse sections of lung tissue were studied in patients by computerized tomography during anaesthesia and in the postoperative period. Eight patients were studied during intravenous (thiopentone) and six during inhalational (halothane) anaesthesia. The latter patients were studied during both spontaneous and mechanical ventilation. Five of the patients who underwent surgery for inguinal hernia and five patients in whom laparotomy was performed were studied 1 h and 24 h postoperatively. No patient showed any lung changes while awake preoperatively, and all patients developed dependent, crest-shaped lung densities within 5-10 min of anaesthesia. The densities comprised 3.4% of the lung volume in the caudal (basal) 5 cm of the lung tissue. No significant differences in the size and distribution of the densities were noted between spontaneous breathing and mechanical ventilation during anaesthesia, or between intravenous and inhalational anaesthesia. The densities remained in nine of ten patients 1 h postoperatively, and they remained in five of ten patients 24 h after anaesthesia. The densities are considered to be compression atelectases which may develop as a result of relaxation of the diaphragm. They may be important contributors to postoperative pulmonary complications.

Validade de um índice prognóstico para ocorrência de complicações pulmonares no pós-operatório de cirurgia abdominal alta

“…Esta variabilidade resulta de estudos retrospectivos, não controlados, cujas medidas de desfecho são diferentes e incluem inclusive febre sem causa determinada, microatelectasias e embolia pulmonar 23,24 .…”

CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

“…If spontaneous breathing is allowed without immediate CPAP, the battle against atelectasis will be lost early and full recovery of the atelectatic portions can be difficult. It is important to note that atelectasis can develop with both inhalational and intravenous anesthesia and whether the patient is spontaneously breathing or is paralyzed and mechanically ventilated [6].…”

Prolonged Thoracic Epidural Anesthesia in the Correction of Hypoxia in the Postoperative Period

“…По данным литературы [2], развитие микроате лектазов, которые не выявляются с помощью рутин ных методов рентгенологического исследования, является ведущей причиной гипоксемии в послеопера ционном периоде. Формирование ателектазов сопро вождает практически любую анестезию вне зависимос ти от ее методики [8] и связано с неподвижностью пациентов, проведением ИВЛ, использованием отно сительно высоких концентраций кислорода. В «боль шой» абдоминальной хирургии дополнительными факторами могут являться: повреждение дыхательных мышц, активизация выдоха, ограничение экскурсии ди афрагмы, затруднение самостоятельного дыхания вследствие выраженного послеоперационного болевого синдрома.…”