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Canadian Journal of Anaesthesia

, Volume 38, Issue 3, pp 384–400 | Cite as

Perioperative functional residual capacity

  • R. W. M. Wahba
Review Articles

Abstract

The literature dealing with the magnitude, mechanism and effects of reduced FRC in the perioperative period is reviewed. During general anaesthesia FRC is reduced by approximately 20%. The reduction is greater in the obese and in patients with COPD. The most likely mechanism is the loss of inspiratory muscle tone of the muscles acting on the rib cage. Gas trapping is an additional mechanism. Lung compiance decreases and airways resistance increases, in large part, due to decreased FRC. The larynx is displaced anteriorly and elongated, making laryngoscopy and intubation more difficult. The change in FRC creates or increases intrapulmonary shunt and areas of low ventilation to perfusion. This is due to the occurrence of compression atelectasis, and to regional changes in mechanics and airway closure which tend to reduce ventilation to dependent lung zones which are still well perfused. Abdominal and thoracic operations tend to increase shunting further. Large tidal volume but not PEEP will improve oxygenation, although both increase FRC. Both FRC and vital capacity are reduced following abdominal and thoracic surgery in a predictable pattern. The mechanism is the combined effect ofincisional pain and reflex dysfunction of the diaphragm. Additional effects of thoracic surgery include pleural effusion, cooling of the phrenic nerve and mediastinal widening. Postoperative hypoxaemia is a function of reduced FRC and airway closure. There is no real difference among the various methods of active lung expansion in terms of the speed of restoration of lung function, or in preventing postoperative atelectasis/pneumonia. Epidural analgesia does not influence the rate of recovery of lung function, nor does it prevent atelectasis/pneumonia.

Key words

Hypoxia: postoperative Lung: functional residual capacity Ventilation: anaesthetics, effects of diaphragm oxygen tension, positive end-expiratory pressure, shunting 

Résumé

La littérature concernant l’importance, le mécanisme et les effets de la réduction de la capacité résiduelle fonctionnelle en période périopératoire est revue. Durant l’anesthésie générale, la CRF est rédidte de 20% approximativement. Cette réduction est plus grande chez les obeses et les patients ayant une maladie pulmonaire obstructive chronique. Le mécanisme le plus probable serait la perte du tonus musculaire inspiratoire des muscles agissant sur la cage thoracique. La captation des gaz serait un mécanisme additionnel. La compliance pulmonaire diminue et la résistance des voies aeriennes augmente en grande partie a cause de la diminution de la CRF. Le larynx est déplacé antérieurement et étiré rendant la laryngoscopie et rendant l’ intubation plus difficiles. Les changements de la CRF créent et augmentent le shunt intrapulmonaire et les régions ayant un bon ratio de ventilation sur perfusion. Ceci est dû à la survenue de l’atélectasie par compression et à des changements régionaux mécaniques et la fermeture des voies aériennes qui tendent à reduire la ventilation aux zones pulmonaires dépendantes qui sont encore bien perfusées. Les opérations abdominales et thoraciques tendent à augmenter davantage le shunt. Le grand volume courant mais non la PEEP améliorerait l’oxygénation même s’il augmente la CRF. Tant la CRF que la capacité vitale sont réduites après chirurgie abdominale et thoracique d’une facon prévisible. Le mécanisme serait l’effet combiné de la douleur incisionnelle et la dysfonction réflexe du diaphragme. Les effets additionnels de la chirurgie thoracique incluent l’epanchement pleural, le refroidissement du nerf phrénique et l’élargissement médiastinal. L’hypoxémie postopératoire est en fonction de la diminution de la CRF et de la fermeture des voies aériennes. Il n’y avail aucune différence réelle entre les différentes méthodes d’expansion active du poumon concernant la rapidité de la restauration de la fonction pulmonaire ou dans la prevention de l’atélectasie postopératoire-pneumonie. L’analgésie épidurale n’influence pas le taux de récupération de la fonction pulmonaire ni ne prévient l’atélectasie-pneumonie.

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Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • R. W. M. Wahba
    • 1
  1. 1.Department of AnaesthesiaQueen Elizabeth Hospital and McGill UniversityMontrealCanada

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