Functional Residual Capacity, Thoracoabdominal Dimensions, and Central Blood Volume during General Anesthesia with Muscle Paralysis and Mechanical Ventilation

Hedenstierna, Göran; Strandberg, Anna K.; Brismar, B.; Lundquist, H.; Svensson, Leif; Tokics, L.

doi:10.1097/00000542-198503000-00007

Cited by 305 publications

(121 citation statements)

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“…The cephalad displacement of the diaphragm, which particularly affects the dorsal position of that muscle, al is variable 42 and is in the order of 1.9 • 0.5 cm. 29 This change in position alters the diameters of the rib cage. There is an increase in the lateral and a decrease in the antero-posterior external diameters.…”

Section: B Mechanisms Of Reduced Frcmentioning

confidence: 99%

“…47 The resulting change in cross-sectional area has been calculated to be equal to a loss in volume of 170 ---140 ml in one report 4s and an average of 300 ml in another. 29 A reduction in tone of the diaphragm or of the muscles acting on the ventilatory pump will lead to a reduction in intragastric pressure (PGA) in lean patients. The average change in PGA immediately following induction of anaesthesia is -40 Pa. 4s Obese patients, however, have relatively more inspiratory tone when awake.…”

Section: B Mechanisms Of Reduced Frcmentioning

confidence: 99%

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Perioperative functional residual capacity

Wahba

1991

Can J Anaesth

224

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Section: B Mechanisms Of Reduced Frcmentioning

confidence: 99%

Section: B Mechanisms Of Reduced Frcmentioning

confidence: 99%

Perioperative functional residual capacity

Wahba

1991

Can J Anaesth

224

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“…2 TELECTASIS observed during general anesthesia causes a decrease in arterial oxygenation, functional residual capacity and respiratory compliance. [1][2][3] Lung recruitment maneuvers are defined as ventilatory strategies used for treating these negative effects of lung collapse. [4][5][6] The goal of these maneuvers is to open up the collapsed lung areas and keep them open over time.…”

mentioning

confidence: 99%

Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia

Tusman

Böhm

Suárez-Sipmann

et al. 2004

Can J Anesth/J Can Anesth

108

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P Pu ur rp po os se e: : The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space.M Me et th ho od ds s: : 16 anesthetized patients were sequentially studied in three steps: 1) without PEEP (ZEEP), 2) with 5 cm H 2 O of PEEP and 3) with 5 cm H 2 O of PEEP after an alveolar recruitment strategy (ARS). Ventilation was maintained constant. The single breath test of CO 2 (SBT-CO 2 ), arterial oxygenation, end-expiratory lung volume (EELV) and respiratory compliance were recorded every 30 min.R Re es su ul lt ts s: : Physiological dead space to tidal volume decreased after ARS (0.45 ± 0.01) compared with ZEEP (0.50 ± 0.07, P < 0.05) and PEEP (0.51 ± 0.06, P < 0.05). The elimination of CO 2 per breath increased during PEEP (25 ± 3.3 mL·min -1 ) and ARS (27 ± 3.2 mL·min -1 ) compared to ZEEP (23 ± 2.6 mL·min -1 , P < 0.05), although ARS showed larger values than PEEP (P < 0.05). Pa-etCO 2 difference was lower after recruitment (0.9 ± 0.5 kPa, P < 0.05) compared to ZEEP (1.1 ± 0.5 kPa) and PEEP (1.2 ± 0.5 kPa).Slope II increased after ARS (63 ± 11%/L, P < 0.05) compared with ZEEP (46 ± 7.7%/L) and PEEP (56 ± 10%/L). Slope III decreased significantly after recruitment (0.13 ± 0.07 1/L) compared with ZEEP (0.21 ± 0.11 1/L) and PEEP (0.18 ± 0.10 1/L). The angle between slope II and III decreased only after ARS. After lung recruitment, PaO 2 , EELV, and compliance increased significantly compared with ZEEP and PEEP.

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“…High oxygen fractions in the gaseous mixture administered during anesthesia promote atelectasis 12 and such effect seems to be exacerbated in obese patients, specially morbidly obese ones 13 . Hedenstierna et al 14 have described decreased functional residual capacity (FRC) promoted by general anesthesia and muscle paralysis under mechanical ventilation caused by diaphragm relaxation. Pelosi et al 13 have proposed that decreased oxygenation and pulmonary volume are inversely related to BMI.…”

Section: Resultsmentioning

confidence: 99%