Journal article
Decrease in functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized preschool children in the lateral position.
- von Ungern-Sternberg BS Division of Anesthesia, University Children's Hospital, Basel, Switzerland. bvonungern@uhbs.ch
- Regli A
- Frei FJ
- Hammer J
- Jordi Ritz EM
- Erb TO
- 2007-08-09
Published in:
- Paediatric anaesthesia. - 2007
Androstanols
Anesthesia, General
Anesthetics, Intravenous
Child
Child, Preschool
Female
Fentanyl
Functional Residual Capacity
Humans
Male
Neuromuscular Blockade
Neuromuscular Nondepolarizing Agents
Positive-Pressure Respiration
Posture
Propofol
Respiratory Mechanics
Rocuronium
Sample Size
English
BACKGROUND
While functional residual capacity (FRC) is reduced in children undergoing general anesthesia, the lateral position leads to an increase in FRC compared with the supine position. The impact of neuromuscular blockade remains unknown. We tested the hypothesis that neuromuscular blockade leads to a decrease in FRC and increase in lung clearance index (LCI) while the application of positive endexpiratory pressure (PEEP) of 6 cmH(2)O leads to a restoration in both parameters.
METHODS
After approval of the local Ethics Committee, we studied 18 preschool children (2-6 years) without cardiopulmonary disease, who were scheduled for elective surgery. Anesthesia was standardized using propofol and fentanyl. FRC and LCI were calculated by a blinded observer using a SF6 multibreath washout technique with an ultrasonic transit-time airflow meter (Exhalyzer D). Measurements were taken in the left lateral position (PEEP 3 cmH2O) after 1. intubation with a cuffed tracheal tube, 2. neuromuscular blockade with rocuronium, and 3. the additional application of PEEP (6 cmH2O).
RESULTS
Functional residual capacity mean (sd) decreased from 31.6 (4.4) ml.kg(-1) to 27.6 (4.2) ml.kg(-1) (P<0.001) following neuromuscular blockade while the LCI increased from 6.54 (0.6) to 7.0 (0.6) (P
CONCLUSIONS
In the lateral position, neuromuscular blockade led to a significant decrease in FRC associated with a small increase in ventilation inhomogeneity. FRC and LCI were restored to baseline levels with the application of PEEP 3 cmH2O that is in addition to a background of PEEP 3 cmH2O giving a total of 6 cmH2O PEEP.
While functional residual capacity (FRC) is reduced in children undergoing general anesthesia, the lateral position leads to an increase in FRC compared with the supine position. The impact of neuromuscular blockade remains unknown. We tested the hypothesis that neuromuscular blockade leads to a decrease in FRC and increase in lung clearance index (LCI) while the application of positive endexpiratory pressure (PEEP) of 6 cmH(2)O leads to a restoration in both parameters.
METHODS
After approval of the local Ethics Committee, we studied 18 preschool children (2-6 years) without cardiopulmonary disease, who were scheduled for elective surgery. Anesthesia was standardized using propofol and fentanyl. FRC and LCI were calculated by a blinded observer using a SF6 multibreath washout technique with an ultrasonic transit-time airflow meter (Exhalyzer D). Measurements were taken in the left lateral position (PEEP 3 cmH2O) after 1. intubation with a cuffed tracheal tube, 2. neuromuscular blockade with rocuronium, and 3. the additional application of PEEP (6 cmH2O).
RESULTS
Functional residual capacity mean (sd) decreased from 31.6 (4.4) ml.kg(-1) to 27.6 (4.2) ml.kg(-1) (P<0.001) following neuromuscular blockade while the LCI increased from 6.54 (0.6) to 7.0 (0.6) (P
CONCLUSIONS
In the lateral position, neuromuscular blockade led to a significant decrease in FRC associated with a small increase in ventilation inhomogeneity. FRC and LCI were restored to baseline levels with the application of PEEP 3 cmH2O that is in addition to a background of PEEP 3 cmH2O giving a total of 6 cmH2O PEEP.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1111/j.1460-9592.2007.02226.x
- PMID 17683401
- Persistent URL
- https://sonar.ch/global/documents/205310
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