Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man.

Westbrook, Philip R.; Stubbs, Samuel E.; Sessler, Alan D.; Rehder, Kai; Hyatt, Robert E.

doi:10.1152/jappl.1973.34.1.81

Cited by 275 publications

(43 citation statements)

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“…The changes are partially but not completely reversed following repeated lung inflations [132]. Similar decreases have been noted in infants and children [133].…”

Section: Changes In Frc During Anaesthesia Mechanical Ventilation Ansupporting

confidence: 74%

Pathophysiology of changes in absolute lung volumes

Bancalari

Clausen

1998

Eur Respir J

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Changes in absolute lung volumes are common in lung disease and result in significant impacts on gas exchange, respiratory muscle function, the sensation of dyspnoea, and limitations to maximal exercise. Though our knowledge regarding the magnitude and determinants of changes in lung volumes in health and disease has increased in the past 20 years, a number of important questions remain unanswered. Consideration of the limitations of specific methods for measuring lung volumes is essential when analysing published studies regarding absolute lung volumes in infants, children and adults. Though functional residual capacity is most commonly measured in children and adults with the subject awake and at rest, increasingly attention is being directed to making these measurements under clinically more relevant conditions (e.g. during exercise, sleep, anesthesia, or mechanical ventilation). The relationships between dynamic changes in functional residual capacity, flow limitation during tidal breaths, sensation of dyspnoea and exercise limitation are important to understand, and are the focus of current and future research. Improved understanding of these relationships may lead to improvements in therapy of patients with acute and chronic lung disease and are likely to be particularly important for evaluating the efficacy of and optimal patient selection for new modes of therapy, such as lung volume reduction surgery.

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“…The changes are partially but not completely reversed following repeated lung inflations [132]. Similar decreases have been noted in infants and children [133].…”

Section: Changes In Frc During Anaesthesia Mechanical Ventilation Ansupporting

confidence: 74%

Pathophysiology of changes in absolute lung volumes

Bancalari

Clausen

1998

Eur Respir J

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“…However, atelectasis commonly occurs in patient without secretions and with normal lungs [25]. On the other hand, anaesthesia is accompanied by a reduction of the rib cage excursions [26], right shift of the pressure-volume curve (reduced "expansion pressure") [27], early airways closure [28], and redistribution of ventilation to the upper lung zones [29]. The increased airway resistance (Raw) [30] is probably merely reflecting the reduced FRC, which in normal subjects is very close to relaxation volume (Vr) of the respiratory system.…”

Section: Discussionmentioning

confidence: 99%

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Barisione¹,

Rovida²,

Gazzaniga³

et al. 1997

Eur Respir J

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We evaluated the capacity to predict severe respiratory complications (SRCs) following upper abdominal surgery (UAS) by using the results of a respiratory questionnaire and preoperative pulmonary function tests.Lung volumes, flows and transfer factor of the lung for carbon monoxide (TL,CO,sb) were assessed in 361 consecutive adult patients (248 males and 113 females). SRCs were diagnosed 24 h after UAS by clinical examination and chest radiography. Univariate and stepwise multiple logistic regression analyses were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each single input variable, and to determine which indices best predicted outcome.These patients had a 1% mortality rate and 14% incidence of SRCs, with a male:female ratio of 0.86. The best predictors for SRCs by multiple analysis were: preoperative current hypersecretion of mucus (OR=133; p<0.0001); an increase in residual volume (RV) (OR=3.11; p=0.01); and, to a lesser extent, low percentage of predicted values both of forced expiratory volume in one second (FEV1 % pred) and TL,CO,sb. The algorithm thus obtained (logit θ) was extremely sensitive (84%), specific (99%), and accurate (95%) for preoperative prediction of SRCs.We have found that preoperative current hypersecretion of mucus and pulmonary hyperinflation, and to a lesser extent percentage predicted values both of forced expiratory volume in one second and transfer factor of the lung for carbon monoxide, have a significant predictive capacity for severe respiratory complications following upper abdominal surgery. Eur Respir J 1997; 10: 1301-1308 Since 1910, it has been well-known that patients undergoing upper abdominal surgery (UAS) generally develop a severe pulmonary restrictive pattern [1], and carry a high risk of postoperative respiratory complications [2][3][4]. The most important factors determining the degree of postoperative impairment of ventilation and gas exchange are the site of operation, the age, and clinical status of the patient [5]. Forced vital capacity (FVC) and peak flows are often reduced to half, and the functional residual capacity (FRC) to below 70% of the preoperative values [5]. These effects may not be restored even by the fifth postoperative day [5]. The reduced FVC and the reduction of FRC are mainly a consequence of an impaired diaphragmatic function [6]. Furthermore, the risk for postoperative respiratory complications decreases with the distance of the surgical incision from the diaphragm [7,8].Several studies have tried to determine the incidence of postoperative respiratory complications of UAS, and the estimates vary widely. The majority of investigations have focused on subclinical complications, i.e. radiographic evidence of atelectasis, with or without pleural fluid. With this broader definition of complication, the incidence of postoperative complications of UAS is approximately 25-75% [9,10].In this paper, we examine the relationship between preoperative respiratory symptoms and physiology, and postoperative r...

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“…The compliance of the thoracic wall is reduced in the anaesthetized state, further decreasing FRC by approximately 20%. 7 Consequently, the chest wall expansion/lung-elastic recoil equilibrium favors smaller lung volumes and closure of susceptible airways especially in dependent areas of the lung. In the pathologic state, such as in the presence of an intrathoracic mass, both anatomic and physiologic perturbations may occur.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic considerations in a patient with an anterior mediastinal mass

Madhusudan¹,

Chaitanya²,

Vinay³

et al. 2013

JCSR

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We report a 35-year-old gentleman who presented to us with respiratory distress. He was diagnosed to have a large anterior mediastinal mass and was and posted for debulking of mediastinal mass. Immediately after intubation, airway collapsed and there was difficulty in ventilating the lungs, followed by drop in oxygen saturation. After sternotomy, oxygen saturation and airway pressures improved. In this report we discussed in detail about the successful anaesthetic considerations for patients with large anterior mediastinal tumour including the management of airway obstruction.

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Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man.

Cited by 275 publications

References 0 publications

Pathophysiology of changes in absolute lung volumes

Pathophysiology of changes in absolute lung volumes

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Anaesthetic considerations in a patient with an anterior mediastinal mass

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