Abstract
Functional residual capacity (FRC), breath-by-breath compliance of the respiratory system (Crs) and arterial oxygen tension (PaO2) were measured in ten children, two months to nine years of age, during anaesthesia for surgical correction of patent ductus arteriosus or coarctation of the aorta. The children were mechanically ventilated with halothane, nitrous oxide and oxygen. F1O2 was kept constant in each child. After induction of anaesthesia, FRC was 17 ± 7 ml·kg-1 (mean ± ISD), corresponding to 60 ± 22 per cent of a predicted awake value. FRC increased to 21 ± 8 ml·kg-1 (p = 0.0005) when the child was turned to its right side and decreased to 13 ± 5 ml·kg-1 (p = 0.0003) when the pleura was opened. No significant change in Crs or Pa02 occurred during these manoeuvres. Retraction of the upper lung to visualize the great vessels caused a significant decrease in FRC, Crs, and Pa02 The lowest PaO2 observed during this stage was 70.0 mmHg. After surgery FRC and PaO2 were about the same as before surgery while Crs had decreased from 0.87 ± 0.18 preoperatively to 0.64 ± 0.15 ml cmH20-1·kg-1 (p = 0.0069). This study shows that FRC increases when mechanically ventilated children are placed in the lateral position, and that thoracotomy is associated with marked changes in FRC, Crs and Pa02
Résumé
La capacité résiduelle fonctionnelle (FRC), la compliance du système respiratoire mesurée è chaque respiration (Csr) et la tension artérielle ďoxygène (PaO2) ont été mesurées chez dix enfants âgés de deux mois è neuf ans lors ďune anesthésie générale pour correction de canal artériel persistant ou de coarctation de ľaorte. Les enfants étaient ventilés mécaniquement avec de ľhalothane, protoxyde ďazote et oxygène. La F1O2 était gardée constante pour chaque enfant. Après ľ induction de ľ anesthésie, la FRC était de 17 ± 7ml·kg-1 (moyenne ± SD), correspondant è 60 ± 22 pour cent de la valeur prédite è ľétat ďéveil. La FRC augmenta de 21 ± 8 ml·kg-1 (p = 0.0005) quand ľenfant était mis en position latérale droite et diminua è 13 ± 5 ml·kg-1 (p = 0.0003) quand la plèvre fut ouverte. Aucun changement significatif n’est survenu dans la Crs ou la PaO2 lors de ces man œuvres. La rétraction du lobe supérieur du poumon afin de visualiser les gros vaisseaux a occasionné une diminution significative de la FRC, Crs et PaO2 La PaO2 la plus basse observée è ce stade était de 70.0 mmHg. Après la chirurgie la FRC et la PaO2 sont revenues aux mêmes valeurs préop alors que la Crs a diminué de 0.87 ± 0.18 en période préopérative è 0.64 ± 0.15 ml·cmH2 -1·kg-1’ (p = 0.0069). Cette étude démontre que la FRC augmente chez les enfants ventilés mécaniquement mis en position latérale et que la thoracotomie est associée è un changement marqué dans la FRC, Crs et Pa02.
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Larsson, A., Jonmarker, C., Jögi, P. et al. Ventilatory consequences of the lateral position and thoracotomy in children. Can J Anesth 34, 141–145 (1987). https://doi.org/10.1007/BF03015331
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DOI: https://doi.org/10.1007/BF03015331