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Atelectasis and pulmonary shunting during induction of general anaesthesia--can they be avoided?

Abstract：

BACKGROUND:Gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. A major cause of this disorder appears to be atelectasis and consequently pulmonary shunt. After re-expansion, atelectasis reappears very slowly if 30% oxygen in nitrogen is used, but much faster if 100% oxygen is used. The aim of the present study-was to evaluate if early formation of atelectasis and pulmonary shunt may be avoided if the lungs are ventilated with 30% oxygen in nitrogen instead of 100% oxygen during the induction of general anaesthesia. METHODS:Twenty-four adult patients with healthy lungs scheduled for elective surgery were investigated. During induction of anaesthesia, the lungs were manually ventilated via a face mask, using either 30% oxygen in nitrogen (group 1, n = 12) or 100% oxygen (group 2, n = 12). Atelectasis was estimated by computed x-ray tomography and ventilation-perfusion distribution with the multiple inert gas elimination technique, both awake and during general anaesthesia with mechanical ventilation. RESULTS:No atelectasis was present in the awake subjects. After induction of anaesthesia, the mean amount of atelectasis was minor (0.2 +/- 0.4 cm2) in group 1 and considerably greater (8.0 +/- 8.2 cm2) in group 2 (P < 0.001). The pulmonary shunt was 0.3 +/- 0.7% of cardiac output in the awake subjects. This value increased to 2.1 +/- 3.8% in group 1 and to 6.5 +/- 5.2% in group 2 (P < 0.05). The indices of VA/Q mismatch showed no difference between the two groups. CONCLUSION:During induction of general intravenous anaesthesia in patients with healthy lungs, gas composition plays an important role for atelectasis formation and the establishment of pulmonary shunt. By using a mixture containing 30% oxygen in nitrogen, the early formation of atelectasis and pulmonary shunt may, at least in part, be avoided.

journal_name

Acta Anaesthesiol Scand

journal_title

Acta anaesthesiologica Scandinavica

authors

Rothen HU,Sporre B,Engberg G,Wegenius G,Reber A,Hedenstierna G

doi

10.1111/j.1399-6576.1996.tb04483.x

subject

Has Abstract

pub_date

1996-05-01 00:00:00

pages

524-9

issue

eissn

0001-5172

issn

1399-6576

journal_volume

pub_type

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Atelectasis and pulmonary shunting during induction of general anaesthesia--can they be avoided?