Canadian Anaesthetists’ Society Journal

, Volume 28, Issue 4, pp 305–313 | Cite as

Pulmonary atelectasis after anaesthesia: Pathophysiology and management

  • John R. A. Rigg
Article

Abstract

The pathophysiological basis of pulmonary atelectasis is reviewed and risk factors that enhance lung collapse are discussed. Management strategies to reduce or eliminate risk factors and to prevent collapse are discussed and the rational bases of these strategies are identified.

Instability of lung alveoli is a consequence of surface tension and regional differences in alveolar size. The inherent tendency of alveoli to collapse is enhanced by the following risk factors; low lung volume, high closing volume, oxygen therapy, a rapid shallow ventilatory pattern, chronic lung disease, smoking, obesity, postoperative pain following abdominal or thoracic surgery, narcotic induced ventilatory depression, and neurological, neuromuscular, muscular and musculoskeletal diseases associated with mechanical impairment of respiratory function. The primary goal of perioperative respiratory management is prevention of atelectasis. Appropriate management strategies include physiotherapy and delay of elective surgery if substantial improvement in respiratory status can be achieved by specific treatments such as antibiotics, bronchodilators, steroids, and reduction of tobacco use and caloric intake. In selected cases, elective postoperative controlled ventilation may be indicated.

Key Words

Anaesthesia Complications atelectasis Lung atelectasis 

Résumé

Ce travail présente une discussion des mécanismes physiopathologiques de l’atélectasie pulmonaire ainsi que des facteurs de risque prédisposant au collapsus pulmonaire. Les différentes approaches en vue d’éliminer ou d’atténuer les effets des facteurs de risque et de prévenir le collapsus pulmonaire sont également discutées dans l’pptique de leur mécanisme d’action.

L’instabilité de l’alvéole pulmonaire est la conséquence naturelle des phénomènes de tension de surface associés aux différences régionales de diamètre alvéolaire. Cette tendance naturelle au collapsus alvéolaire est amplifiée en présence des facteurs de risque suivants: bas volumes pulmonaires, hauts volumes de fermeture, oxygénothérapie, ventilation rapide et superficielle, pathologies pulmonaires chroniques, tabac, obésité, douleurs post-opératoires en chirurgie abdominale ou thoracique, atteintes neurologiques, neuro-musculaires ou musculo-squelettiques avec répercussions sur la ventilation.

Les soins respiratoires péri-opératoires sont axés sur la prévention de l’atélectasie pulmonaire. A cet effet on recommande la physiothérapie et la remise à plus tard des cas de chirurgie élective lorsqu’une amélioration significative de la fonction respiratoire est possible avec une thérapie spécifique (antibiotiques, broncho-dilatateurs, stéroïdes, diminution du tabac et de l’apport calorique). Dans certains cas particuliers un support ventilatoire post-opératoire avec respiration contrôlée peut être indiqué.

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Copyright information

© Canadian Anesthesiologists 1981

Authors and Affiliations

  • John R. A. Rigg
    • 1
  1. 1.Department of AnaesthesiaMcMaster UniversityUSA

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