Alveolar Stability during Anaesthesia for Reconstructive Vascular Surgery in the Leg

Lundh, R.; Johansson, Helena

doi:10.1111/j.1399-6576.1983.tb01900.x

Cited by 36 publications

(22 citation statements)

References 23 publications

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“…The alterations in P(~-ET)co, could also be related to an impairment in gas exchange occurring with prolongation of anesthesia (27). Gunnarsson et al (28) observed that patients under enfluranehitrous oxide anesthesia exhibited significant increases in shunt and large increases in atelectasis between 30 and 90 min after induction of anesthesia.…”

Section: Discussionmentioning

confidence: 97%

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Variation in Arterial to End-Tidal CO2 Tension Differences During Anesthesia in the ???Kidney Rest??? Lateral Decubitus Position

Pansard

Cholley²,

Devilliers³

et al. 1992

Anesthesia & Analgesia

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The course of arterial to end-tidal carbon dioxide tension difference [P(a-ET)CO2] was evaluated during general anesthesia in 25 patients scheduled for renal surgery performed in the "kidney position." The difference between arterial PCO2 (PaCO2) corrected to body temperature, and end-tidal PCO2 (PETCO2) measured by mass spectrometry was assessed after induction of anesthesia, after placement in the lateral decubitus position with back arched over a kidney bridge ("kidney position"), and every 20 min until the patients were replaced in the supine position at the end of the surgical procedure. Heart rate, arterial blood pressure, and esophageal temperature were simultaneously recorded. After induction of anesthesia, when the patients were lying supine (T1), P(a-ET)CO2 was 4.8 +/- 3.9 mm Hg (mean +/- SD). Placing the patients in the kidney position (T2) induced a significant increase in P(a-ET)CO2 (to 7.9 +/- 3.5 mm Hg; P less than 0.01). These alterations occurred without any significant change in mean arterial blood pressure or heart rate. A progressive increase in mean P(a-ET)CO2 occurred with maintenance of anesthesia; P(a-ET)CO2 reached 8.8 +/- 4.1 mm Hg (P less than 0.05 vs T2) and 8.9 +/- 4.4 mm Hg (P less than 0.05 vs T2) at 65 and 85 min, respectively, after lateral decubitus positioning. Large variations between and within patients were observed. Although stable mean arterial pressure was maintained, these changes were associated with a significant decrease in body temperature. These results demonstrate that P(a-ET)CO2 increases when patients are placed in the kidney position and may vary with the prolongation of anesthesia in this situation.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 97%

“…Several studies have been performed to evaluate the difference between arterial and end-tidal CO, measurements in adults or children under general anesthesia (4,8, [14][15][16][17][18][19][20][21][22][23][24][25][26][27]; values between 3 and 5.2 mm Hg have been reported. This variable was generally obtained with the patients lying supine.…”

Section: Discussionmentioning

confidence: 99%

Variation in Arterial to End-Tidal CO2 Tension Differences During Anesthesia in the ???Kidney Rest??? Lateral Decubitus Position

Pansard

Cholley²,

Devilliers³

et al. 1992

Anesthesia & Analgesia

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“…The inert gas preparation, infusion, and blood and gas sampling were undertaken as described above. Details of the gas chromatographic analysis have been described in a previous paper (Hedenstierna, Lundh and Johansson 1983). A Hewlett Packard 9820A gas chromatograph was used in this study.…”

Section: Catheterisation and Analysesmentioning

confidence: 99%

Ventilation‐perfusion relationships in the standing horse: An inert gas elimination study

Hedenstierna¹,

Nyman

Kvart

et al. 1987

Equine Veterinary Journal

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Summary The multiple inert gas elimination technique was adapted for use in the conscious standing horse. The modifications included increased infusion rate of the inert gases (30 ml/min), extended infusion time (60 mins) in order to reach steady state, and construction of a nose mask mixing box system for collection of expired gas. Eight adult horses with a mean weight of 454 kg and a mean age of 6.1 years were studied while standing under resting conditions. Ventilation was 65.2 litres/min and cardiac output measured by thermodilution 40.2 litres/min. Systemic and pulmonary artery mean pressures were 114 and 26 mmHg, respectively. Three horses showed a unimodal V̇A/Q̇ distribution centred upon a mean V̇A/Q̇ of one. Five horses had a bimodal distribution with an additional high V̇A/Q̇ mode comprising 2 to 18 per cent of ventilation. The mean logarithmic standard deviation of perfusion was 0.41. There was no perfusion of Mow' V̇A/Q̇ regions, but minor shunting on an average of 1 per cent was noted. Inert gas dead space (minus apparatus dead space) averaged 38 per cent of total ventilation. Arterial oxygen tension varied from 11 to 14 kPa and the mean arterial CO2 tension was 5.7 kPa. It is concluded that the standing horse in general has a good match between ventilation and perfusion but that some individuals display high V̇A/Q̇ regions, possibly explained by poor perfusion of upper lung regions.

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“…I n the present study a residual sum of squares of less than 10 was accepted, indicating a reasonable fit to the model or minor degree of experimental error. In previous studies on VA/Q (3,4), the same criteria have been used, permitting a direct comparison of data on these grounds. In previous studies, we have shown an increased dispersion of perfusion during general anaesthesia with an increased perfusion to regions with low TjA /&ratioS (3, 4).…”

Section: Discijssionmentioning

confidence: 99%

“…It is a well-known fact that general anaesthesia causes impairment of pulmonary gas exchange. Using the inert gas elimination technique (I), it has been shown that general anaesthesia causes mismatching of ventilation and perfusion in the lungs (2,3,4) with an increase in perfusion to regions with low VAIQratios. An explanation for these findings may well be an increase in airway closure, that is the closing of small airways above or within the tidal breath in lower lung regions.…”

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confidence: 99%

Ventilation‐Perfusion Relationships During Epidural Analgesia

Lundh

Hedenstierna

Johansson

1983

Acta Anaesthesiol Scand

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Resting lung volume (FRC), airway closure (CC) and ventilation-perfusion relationships, using the multiple inert gas elimination technique, were studied during epidural analgesia. The material consisted of 10 patients, 55-84 years of age. Epidural blockade (9-13 ml mepivacaine-adr, 1/200,000) was instituted to an upper level corresponding to Th3-Th6. Minute ventilation and breathing frequency remained unchanged during the epidural block, while cardiac output was significantly increased (4.80-5.74 l/min). The relationship between FRC and CC (FRC-CC) was unchanged during the block, indicating an unchanged magnitude of airway closure. Multiple inert gas elimination data revealed virtually unchanged distribution of ventilation and perfusion during the epidural block in 9 of the 10 patients. It is concluded that lumbar epidural analgesia up to Th3-Th6 does not influence the degree of airway closure, nor does it cause VA/Q mismatching as general anaesthesia does.

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Alveolar Stability during Anaesthesia for Reconstructive Vascular Surgery in the Leg

Cited by 36 publications

References 23 publications

Variation in Arterial to End-Tidal CO2 Tension Differences During Anesthesia in the ???Kidney Rest??? Lateral Decubitus Position

Variation in Arterial to End-Tidal CO2 Tension Differences During Anesthesia in the ???Kidney Rest??? Lateral Decubitus Position

Ventilation‐perfusion relationships in the standing horse: An inert gas elimination study

Ventilation‐Perfusion Relationships During Epidural Analgesia

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