Effects of anaesthesia on paediatric lung function

Trachsel, Daniel; Svendsen, Jan; Erb, Thomas O.; Ungern‐Sternberg, Britta S. von

doi:10.1093/bja/aew173

Cited by 50 publications

(70 citation statements)

References 183 publications

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“…Various ventilation approaches have been considered to counteract the deleterious effects of laparoscopy on lung volume. The application of appropriate PEEP level is the most suitable means to avoid reduced lung volumes, atelectasis formation, and subsequent gas exchange deterioration 14 . Therefore, the results of the present study provide new and interesting information on how to ventilate neonates and small children who undergo laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 79%

Determination of adequate positive end‐expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy

Karlsson

Fodor

Rocha

et al. 2020

Acta Anaesthesiol Scand

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Background Capnoperitoneum provides a ventilatory challenge due to reduction in end‐expiratory lung volume and peritoneal carbon dioxide absorption in both children and adults. The primary aim of this controlled interventional trial was to determine the positive end‐expiratory pressure (PEEP) level needed to ensure for adequate carbon dioxide clearance and preservation of carbon dioxide homeostasis in an experimental model of infant laparoscopy. The secondary aim was to evaluate potential effects on cardiac output of PEEP and abdominal pressure level variations in the same setting. Methods Eight chinchilla bastard rabbits were anesthetized and mechanically ventilated. Intra‐abdominal pressures were randomly set to 0, 6, and 12 mm Hg by carbon dioxide insufflation. Carbon dioxide clearance using volumetric capnography, arterial blood gas data, and cardiac output was recorded, while PEEP 3, 6, and 9 cmH2O were applied in a random order. Results A PEEP of 9 cmH2O showed restoration of carbon dioxide clearance without causing changes in arterial partial pressure of carbon dioxide and bicarbonate and with no associated deterioration in cardiac output. Conclusion The results promote a PEEP level of 9 cmH2O in this model of infant capnoperitoneum to allow for adequate carbon dioxide removal with subsequent preservation of carbon dioxide homeostasis. The use of high PEEP was not associated with any decrease in cardiac output.

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Section: Discussionmentioning

confidence: 79%

Determination of adequate positive end‐expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy

Karlsson

Fodor

Rocha

et al. 2020

Acta Anaesthesiol Scand

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“…Following the onset of apnoea, hypoxaemia develops more rapidly in children than in adults, as a result of increased oxygen consumption, a smaller functional residual capacity and increased closing capacity [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…However, in all but three of these patients, the study was terminated due to hypercarbia or a time limit of 10 min, such that the event of relevance to the primary outcome, arterial oxygen desaturation, did not occur with sufficient frequency to make a comparison between lowflow and high-flow nasal oxygen[36]. Airway closure occurs more readily in children than adults at induction of anaesthesia, accelerating ventilation-perfusion mismatch and, thus, hypoxaemia[8].Prolonged oxygenation in these clinical studies demonstrates the potential for high-flow nasal oxygen to retain an open communication between the upper airway and alveoli for a longer duration, delaying the adverse effects of airway closure. Apnoeic ventilation Our understanding of increased arterial partial pressure of carbon dioxide (PaCO 2 ) in an aventilatory state has originated from the study of apnoeic intubated patients.…”

mentioning

confidence: 99%

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Lyons

Callaghan

2020

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.

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“…Positive pressure MV can cause VILI even when applied for short periods of time, and the role of protective MV during anesthesia has become important for preventing postoperative complications [ 5 – 10 ]. Although the exact incidence of VILI during general anesthesia is unknown, the lungs of patients under general anesthesia are especially vulnerable to VILI, since anesthetic induction reduces the end expiratory lung volume (EELV) by 9–25% in adults and up to 46% in children [ 11 – 15 ]. Cyclic opening and collapsing of alveoli have been indicated as one of the primary mechanisms of VILI during anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Positive end-expiratory pressure improves elastic working pressure in anesthetized children

et al. 2018

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BackgroundPositive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children.MethodsPatients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman’s analysis were used. Significance was set at P < 0.05.ResultsWe included 30 patients, median age 39 (15–61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg− 1·cmH2O− 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min− 1 (all P < 0.01). There were no significant changes in resistance and QI.ConclusionsAnalysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0611-8) contains supplementary material, which is available to authorized users.

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Effects of anaesthesia on paediatric lung function

Cited by 50 publications

References 183 publications

Determination of adequate positive end‐expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy

Determination of adequate positive end‐expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Positive end-expiratory pressure improves elastic working pressure in anesthetized children

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