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Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Politecn Milan, TBM Lab, Dipartimento Elettron Informaz & Bioingn, Pzza L da Vinci 32, I-20133 Milan, Italy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.ORCID iD: 0000-0002-0702-8343
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 3, p. 282-292Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles.

METHODS: Eighteen ASA I-II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2 O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2 ) or a control group, ventilated without LRM, with 0 cmH2 O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients.

RESULTS: End-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation.

CONCLUSION: A combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase.

Place, publisher, year, edition, pages
2018. Vol. 62, no 3, p. 282-292
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-334187DOI: 10.1111/aas.13026ISI: 000424150200001PubMedID: 29105056OAI: oai:DiVA.org:uu-334187DiVA, id: diva2:1158894
Funder
Swedish Heart Lung FoundationSwedish Research Council, 5315, K2015-99X-22731-01-4Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-03-15Bibliographically approved

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Kostic, PeterLo Mauro, AntonellaLarsson, AndersHedenstierna, GöranFrykholm, Peter

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