Lung Function in the Supine and Lateral Decubitus Positions in Anaesthetized Infants and Children †

Abstract

We have measured dynamic lung compliance or static lung thorax compliance, functional residual capacity (FRC), and two indices of pulmonary gas mixing (pulmonary clearance delay (PCD) and single breath alveolar mixing efficiency (SBAME)) in 25 children in the supine and lateral decubitus position during nitrous oxide-halothane anaesthesia. Fifteen children (5 month-8 yr) breathed spontaneously and 10 (4 month-9 yr) underwent mechanical ventilation. Tidal volume and rate of ventilation were, respectively, 3.5-6.6 ml kg-1 and 22-46 b.p.m. in spontaneously breathing supine children, and 8.3-15 ml kg-1 and 20-30 b.p.m. in mechanically ventilated supine children, and did not differ significantly in the lateral position. There was no significant change in compliance when the child was turned to the lateral position, but FRC increased from 22 (SD7) to 25 (8) ml kg-1 (P less than 0.01) in the spontaneously breathing group and from 19 (6) to 24 (8) ml kg-1 (P less than 0.01) in the other group. In spontaneously breathing children, PCD and SBAME indicated a somewhat impaired pulmonary gas mixing (P less than 0.05) after the child had been turned to the lateral position, but no change occurred in the other group. These findings suggest that the distribution of ventilation in anaesthetized children in the lateral position is similar to that reported previously in anaesthetized adults.

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

“…The baseline measurements of compliance during anesthesia and controlled ventilation were similar to those reported in another study of young children [19]. Casting produced a precipitous increase in PIP (p < 0.0001) and decrease in compliance (p < 0.0001) ( Table 1).…”

Distribution of lung ventilation in spontaneously breathing neonates lying in different body positions

“…However, the largest problem of studies on subjects in this age group is the fact that neonates are non-cooperative. In view of these considerations it is no wonder that our knowledge on the spatial distribution of lung ventilation and the effect of body posture on respiration in neonates is limited to data obtained in sedated or anaesthetised infants [17,18,19], in infants with lung [17,19,20] or other disease [18], during mechanical ventilation [18,19,20] and in subject groups with large age heterogeneity [17,18,21].…”

Anaesthesia for thoracic surgery in children

“…Older children increase functional residual capacity (FRC) on adoption of this position while breathing spontaneously. Pulmonary gas mixing becomes uneven, but total compliance is unchanged ( 16). In children younger than 2.5 years, total compliance increases on adoption of the lateral position without demonstrable change in FRC ( 16, 17).…”