Position and Motion of the Human Diaphragm during Anesthesia-paralysis

Krayer, S.; Rehder, Kai; Vettermann, J.; Didier, Edward P.; Ritman, Erik L.

doi:10.1097/00000542-198906000-00002

Cited by 170 publications

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“…Another observation in the present study was that the diaphragm displacement was smaller during anaesthesia and muscle paralysis than when in the awake state, as reported earlier by Krayer et al [3]. This reflects the larger resistance to displacing the diaphragm relative to expanding the rib cage.…”

Section: Tidal Excursion Of the Diaphragmsupporting

confidence: 86%

“…Each of these analytical techniques is based on radiological principles, but spiral CT seems to offer the highest resolution, although it requires a prolonged apnoea time that may allow movement of the diaphragm during exposure, particularly in the awake subject. The multiexposure technique that has been used by the Mayo Clinic group does not suffer from any influence of time, but its resolution is unclear [3,4,10]. Finally, the cineradiography used by Froese and Bryan has the advantage of a good time resolution but is two-dimensional and requires exposures in two planes to enable a three-dimensional reconstruction [9].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…The causes of an altered respiratory movement have been discussed in previous studies [3,4,9] and will not be dealt with here. Another observation in the present study was that the diaphragm displacement was smaller during anaesthesia and muscle paralysis than when in the awake state, as reported earlier by Krayer et al [3].…”

Section: Tidal Excursion Of the Diaphragmmentioning

confidence: 99%

“…A cephalad displacement of the diaphragm may be explained by loss of respiratory muscle tone, allowing the abdominal contents to elevate the diaphragm. However, studies by Krayer et al suggested that the diaphragm, on average, does not move cephalad during anaesthesia in the supine patient [3]. Warner et al observed regional differences in diaphragm displacement with cephalad movement of the posterior region and caudad movement of the anterior region [4].…”

mentioning

confidence: 99%

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Position and shape of the diaphragm: implications for atelectasis formation

1998

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SummaryTo evaluate diaphragm movement, 18 consecutive patients undergoing surgery under general anaesthesia were allocated to Group 1 (n ¼ 9: no neuromuscular paralysis) or Group 2 (n ¼ 9: neuromuscular paralysis achieved with pancuronium). Spiral computerised tomography was performed awake and during anaesthesia at end-expiratory level and, additionally, in four patients (Group 2) at end-inspiration for subsequent analysis. There was a significant cephalad displacement of the most cephalad point of the diaphragm dome at functional residual capacity, particularly in its dependent portion, in the pancuronium group. During anaesthesia with no persisting muscle paralysis, there was only a minor and insignificant cephalad shift of the diaphragm dome. However, regional analysis showed that the most dorsal part of the diaphragm was significantly displaced cephalad. Compared with conscious, spontaneous breathing, mechanical ventilation decreased the inspiratory displacement of the dependent part of the muscle. This minor movement of the diaphragm may play an additional role in atelectasis formation.

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Section: Tidal Excursion Of the Diaphragmsupporting

confidence: 86%

Section: Comparison With Previous Workmentioning

confidence: 99%

Section: Tidal Excursion Of the Diaphragmmentioning

confidence: 99%

mentioning

confidence: 99%

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Position and shape of the diaphragm: implications for atelectasis formation

1998

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“…Two mechanisms contribute to perioperative atelectasis: compression and absorption. Compression results from cephalad displacement of diaphragm, decreased compliance, and reduced functional residual capacity [76]. To some extent, these factors contribute with any anesthetic technique.…”

Section: Supplemental Oxygen Is Safementioning

confidence: 99%

Non-pharmacologic Prevention of Surgical Wound Infection

Sessler

2006

Anesthesiology Clinics of North America

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Wound infections are serious and relatively common postoperative complications. They are generally detected five to nine days after surgery and are usually attributed, even by surgeons, to poor surgical technique or failure to maintain sterility. However, it has been known for decades that all wounds become contaminated, often by bacteria from the skin or within the patient, and that it is host defense mechanisms that prevent most contamination from developing into clinical infections. Host defense is especially important during the initial hours following contamination, i.e., the immediate perioperative period.As might thus be expected, factors that improve host defense reduce infection risk. Many of these are under the direct control of anesthesiologists and are at least as important as appropriate use of prophylactic antibiotics, which halve infection risk [1]. This article will review nonpharmacologic methods of reducing infection risk, with special emphasis on methods available to anesthesiologists.

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Gas Exchange in the Respiratory Distress Syndromes

Albert

Jobe

2012

Comprehensive Physiology

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This article describes the gas exchange abnormalities occurring in the acute respiratory distress syndrome seen in adults and children and in the respiratory distress syndrome that occurs in neonates. Evidence is presented indicating that the major gas exchange abnormality accounting for the hypoxemia in both conditions is shunt, and that approximately 50% of patients also have lungs regions in which low ventilation-to-perfusion ratios contribute to the venous admixture. The various mechanisms by which hypercarbia may develop and by which positive end-expiratory pressure improves gas exchange are reviewed, as are the effects of vascular tone and airway narrowing. The mechanisms by which surfactant abnormalities occur in the two conditions are described, as are the histological findings that have been associated with shunt and low ventilation-to-perfusion.

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Position and Motion of the Human Diaphragm during Anesthesia-paralysis

Cited by 170 publications

References 0 publications

Position and shape of the diaphragm: implications for atelectasis formation

Position and shape of the diaphragm: implications for atelectasis formation

Non-pharmacologic Prevention of Surgical Wound Infection

Gas Exchange in the Respiratory Distress Syndromes

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