Effects of Surgical Pneumothorax on Pulmonary Ventilation

Bonica, John J.; Wilson, Joseph F.; Goodson, David N.; Ziegler, Thomas Q.; Murphy, Thomas O.; Downes, John J.; Takamura, John

doi:10.1097/00000542-196111000-00014

Anesthesiology

1961

DOI: 10.1097/00000542-196111000-00014

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Effects of Surgical Pneumothorax on Pulmonary Ventilation

John J. Bonica¹,

Joseph F. Wilson²,

David N. Goodson³

et al.

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1962

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Cited by 8 publications

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“…Arterial blood samples were taken during the following phases: (1) during the preoperative period, (2) 20 minutes after anesthesia was initi¬ ated but before the start of the operation while the patient was still in the supine position, (3) 20 minutes after the patient had been placed in the lateral position, (4) 20 minutes after the chest was opened with both lungs ventilated, (5) 20 min¬ utes after complete collapse of the lung had been effected, (6) 20 minutes after partial collapse of the lung had been effected, and ( 7 ) 20 minutes after the lung tissue which remained, had been reexpanded. Additional measurements were made as follows: after 45 to 60 minutes of complete collapse in 9 patients, after the patient had been ventilated with 100% oxygen administered for 20 minutes dur¬ ing complete and partial collapse of the lung, but after measurements of Phases 5 and 6 had been made in 5 patients, 20 minutes after 6 patients had ventilated at 50%, 75%, and 100% or more of the precollapse minute volume.…”

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Factors Which Affect Ventilatory Function During Surgical Pneumothorax

Bonica¹,

Green²,

Takamura³

et al. 1962

JAMA

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During surgical pneumothorax operations, measurements were made of the oxygen saturation, pH, and pCO2 of the arterial blood in 32 patients, and the circulatory effect of collapse of the operated lung was observed by determining these 3 quantities. The values obtained indicated that, in patients with minimal or moderate unilateral disease, the total collapse of the operated lung was followed by diversion of the blood flow to the unoperated side. In patients with extensive disease of the operated lung, the absence of change in the 3 variables indicated a preexisting diversion of the blood from the diseased lung. In patients with severe bilateral disease, the data indicated a minimal diversion of the blood. DURING the past quarter of a century the dis¬ turbances of ventilatory functions produced by surgical pneumothorax have been the subject of numerous laboratory and clinical studies. As a result, there is available a vast mass of data, but unfortunately many of these are conflicting, prob¬ ably because of the great variety of animal species and preparations and investigative techniques used. Consequently, despite the surfeit of data many aspects of the subject remain incomplete. One of the most important of these, at least from a clinical viewpoint, is the relation of the degree of collapse and the magnitude of dysfunctions to the various factors which determine this relationship. In the past it was generally assumed that the greater the degree of pneumothorax, the more serious the inter¬ ference with ventilation and circulation. This con¬ cept has caused many surgeons to compromise operating conditions in their desire to minimize the degree of dysfunction. However, with the advent of operations requiring collapse of major portions of lungs and the use of endobronchial anesthesia and of bronchial blockers, evidence began to accumulate that cast doubt on this concept. In order to help resolve this and other problems, we have embarked on a long-term study. In the initial report ' data on 19 patients were presented which indicated that the magnitude of arterial oxygen desaturation and hypercarbia was not as great as expected. The study has been extended in an attempt to delineate the role played by various factors and to elucidate on the homeostatic mecha¬ nisms which are brought into play during surgical pneumothorax. The purpose of this communication is to present data pertinent to the surgical and anesthesiologic factors which determine the degree of ventilatory impairment. MethodsThe method of study has been detailed in the first report.' Briefly, it entailed measurements of arterial oxygen saturation, carbon dioxide tension, and pH during various phases of surgical pneumo¬ thorax in 32 patients undergoing intrathoracic op¬ erations for pulmonary tuberculosis (14), neoplastic From the

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confidence: 99%

Factors Which Affect Ventilatory Function During Surgical Pneumothorax

Bonica¹,

Green²,

Takamura³

et al. 1962

JAMA

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A study of oxygenation during thoracotomy

Browne¹,

Catton²,

Ashworth³

1968

Can. Anaes. Soc. J.

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Ventilation and blood gases in anaesthetized patients

Gold

Helrich

1967

Can. Anaes. Soc. J.

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RECENTLY the safety of intermittent positive pressure breathing (IPPB) from the standpoint of oxygenation has been questioned. An increase in physiologic dead space (VD (phys)) and ventilation-perfusion inequality have been demonstrated during IPPB in both awake and anaesthetized subjects. 1-n An anatomical shunt with venous admixture may result from ventilation with constant volumes. The degree of this disturbance, the time relationships between onset and maximum hypoxaemia, and its clinical significance remain to be evaluated.The purpose of this study was to evaluate the significance of blood gas changes during anaesthesia and IPPB. Although evidence is available to the contrary, we wanted to test the validity of the assumption that during the awake, spontaneously breathing state and the anaesthetized IPPB state similar inhaled oxygen tensions (Pro_o), tidal volumes (VT), and respiratory rates (f) should provide similar blood gas values in the same patient. Results proved that the assumption was not valid, although in many instances higher arterial oxygen tensions occurred at tidal volumes considerably less than are used during the management of clinical anaesthesia. EXPERIMENTAL METHODSurgical patients were placed on the operating table one hour after the int~:amuscular injection of 100 mg. pentobarbital and 0.5 mg. atropine. A Courhand needle was placed in the brachial artery and an intravenous infusion of 5 per cent dextrose and water initiated. A mouthpiece was inserted and a nose clip applied. After a tight seal was ensured, a recently calibrated Wrigh.t respirometer was attached to measure expiratory VT and minute volume (VE). Two arterial samples were withdrawn in the conscious state, the first while the patient was breathing air. A non-rebreathing valve and reservoir bag with 100 per cent oxygen were then attached. This was followed by 5 minutes of denitrogenation and, in turn, succeeded by 5 minutes of inhalation of 50 per cent oxygen in nitrogen through the same breathing syste~.n. The second arterial sample (the awake control) was then withdrawn while VE and f were again measured.Thiopental was then injected intravenously followed by succinylcholine. The trachea was then intubated. Fifty per cent 02 in N.oO-halothane was inhaled and the patients' respirations were controlled with the same pressure-regulated ventilator during all subsequent measurements. This 02 concentration was maintained and monitored at a point distal to the inspiratory valve in a circle CO2 absorption

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Effects of Surgical Pneumothorax on Pulmonary Ventilation

Cited by 8 publications

References 0 publications

Factors Which Affect Ventilatory Function During Surgical Pneumothorax

Factors Which Affect Ventilatory Function During Surgical Pneumothorax

A study of oxygenation during thoracotomy

Ventilation and blood gases in anaesthetized patients

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