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Effects of prone position on alveolar dead space and gas exchange during general anaesthesia in surgery of long duration

Published online by Cambridge University Press:  01 May 2007

M. Soro ,
M. L. García-Pérez ,
F. J. Belda ,
R. Ferrandis ,
G. Aguilar ,
G. Tusman  and
F. Gramuntell
M. Soro
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
M. L. García-Pérez
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
F. J. Belda*
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
R. Ferrandis
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
G. Aguilar
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
G. Tusman
Affiliation:
Hospital Privado de Comunidad, Department of Anaesthesia, Mar del Plata, Argentina
F. Gramuntell
Affiliation:
Hospital Arnau de Vilanova, Department of Anaesthesia and Critical Care, Valencia, Spain
*
Correspondence to: F. Javier Belda, Department of Anesthesia and Critical Care, Hospital Clinico Universitario, Avenida Blasco Ibanez, 17. 46010 Valencia, Spain. E-mails: [email protected], [email protected]; Tel: +34 963862653; Fax: +34 963862644
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Summary

Background and objective

We investigated the effects of prone position on respiratory dead space and gas exchange in 14 anaesthetized healthy patients undergoing elective posterior spinal surgery of more than 3 h of duration.

Methods

The patients received a total intravenous anaesthetic with propofol/remifentanil/cisatracurium. They were ventilated at a tidal volume of 8–10 mL kg−1, zero positive end-expiratory pressure and an inspired oxygen fraction of 0.4. Physiological, airway and alveolar dead spaces were calculated by analysis of the volumetric capnography waveform. Measurements were made in supine position (20 min after the beginning of mechanical ventilation) and 30, 120 and 180 min after turning to prone position.

Results

We found that the alveolar dead space/tidal volume ratio did not change. PaO2/FiO2 increased, although not statistically significantly. Dynamic compliance was reduced due to a reduction in tidal volume and an increase in plateau pressure.

Conclusions

Patients undergoing surgery in prone position for a duration of 3 h under general anaesthesia including muscle relaxation and mechanical ventilation without positive end-expiratory pressure have stable haemodynamics and no significant changes in the alveolar dead space to tidal volume ratio. Oxygenation tended to improve.

Keywords

RESPIRATORY DEAD SPACEPULMONARY GAS EXCHANGEPRONE POSITIONSURGERYLONG DURATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 431 - 437
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Lumb, AB, Nunn, JF. Respiratory function and rib cage contribution to ventilation in body positions commonly used during anesthesia. Anesth Analg 1991; 73: 422–426.CrossRefGoogle ScholarPubMed
2.Pelosi, P, Massimo, C, Calappi, E et al. . The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995; 80: 955–960.Google ScholarPubMed
3.Pelosi, P, Croci, M, Calappi, E et al. . Prone positioning improves function in obese patients during general anesthesia. Anesth Analg 1996; 83: 578–583.CrossRefGoogle ScholarPubMed
4.Nyren, S, Mure, M, Jacobsson, H, Larsson, SA, Lindahl, SG. Pulmonary perfusion is more uniform in the prone than in the supine position: scintigraphy in healthy humans. J Appl Physiol 1999; 86: 1135–1141.CrossRefGoogle ScholarPubMed
5.Mure, M, Domino, KB, Lindahl, SG, Hlastala, MP, Altemeier, WA, Glenny, RW. Regional ventilation-perfusion distribution is more uniform in the prone position. J Appl Physiol 2000; 88: 1076–1083.CrossRefGoogle ScholarPubMed
6.Casati, A, Salvo, I, Torri, G, Calderini, E. Arterial to end-tidal carbon dioxide gradient and physiological dead space monitoring during general anaesthesia: effects of patients’ position. Minerva Anestesiol 1997; 63: 177–182.Google ScholarPubMed
7.Wahba, R, Tessler, M, Kardash, K. Carbon dioxide tensions during anesthesia in the prone position. Anesth Analg 1998; 86: 668–669.Google ScholarPubMed
8.Lynch, S, Brand, L, Levy, A. Changes in lung-thorax compliance during orthopedic surgery. Anesthesiology 1959; 20: 278–282.CrossRefGoogle ScholarPubMed
9.Safar, P, Aguto-Escarraga, L. Compliance in apneic anesthetized adults. Anesthesiology 1959; 20: 283–289.CrossRefGoogle ScholarPubMed
10.Palmon, S, Kirsch, J, Depper, J, Toung, T. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesth Analg 1998; 87: 1175–1180.CrossRefGoogle ScholarPubMed
11.Smith, RH. One solution to the problem of the prone position for surgical procedures. Anesth Analg 1974; 53: 211–224.CrossRefGoogle Scholar
12.Fowler, WS. Lung function studies. V. Respiratory dead space in old age and in pulmonary emphysema. J Clin Invest 1950; 29: 1439–1444.CrossRefGoogle ScholarPubMed
13.Arnold, JH, Thompson, JE, Arnold, LW. Single breath CO2 analysis: description and validation of a method. Crit Care Med 1996; 24: 96–102.CrossRefGoogle ScholarPubMed
14.Rocco, M, Spadetta, G, Morelli, A et al. . A comparative evaluation of thermodilution and partial CO2 rebreathing techniques for cardiac output assessment in critically ill patients during assisted ventilation. Intensive Care Med 2004; 30: 82–87.CrossRefGoogle ScholarPubMed
15.Jover, JL, Soro, M, Belda, FJ, Aguilar, G, Caro, P, Ferrandis, R. Measurement of cardiac output after cardiac surgery: validation of a partial carbon dioxide rebreathing (NICO) system in comparison with continuous thermodilution with a pulmonary artery catheter. Rev Esp Anestesiol Reanim 2005; 52: 256–262 (Spanish).Google ScholarPubMed
[16]Fletcher, R, Jonson, B. Deadspace and the singlebreath test for carbon dioxide during anaesthesia and artificial ventilation. Effects of tidal volume and frequency of respiration. Br J Anaesth 1984; 56: 109–119.CrossRefGoogle Scholar
17.Taskar, V, John, J, Larsson, A, Wetterberg, T, Jonsson, B. Dynamics of carbon dioxide elimination following ventilator resetting. Chest 1995; 108: 196–202.CrossRefGoogle ScholarPubMed
18.LaMantia, KR, O’Connor, T, Barash, PG. Comparing methods of measurement: An alternative approach. Anesthesiology 1990; 72: 781–783.CrossRefGoogle ScholarPubMed
19.Blanch, L, Lucangelo, U, Lopez-Aguilar, J, Fernandez, R, Romero, PV. Volumetric capnography in patients with acute lung injury: effects of positive end-expiratory pressure. Eur Respir J 1999; 13: 1048–1054.CrossRefGoogle ScholarPubMed
20.Kallet, RH, Daniel, BM, Garcia, O, Matthay, MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care 2005; 50: 462–467.Google ScholarPubMed
21.Praetel, C, Banner, MJ, Monk, T, Gabrielli, A. Isoflurane inhalation enhances increased physiologic deadspace volume associated with positive pressure ventilation and compromises arterial oxygenation. Anesth Analg 2004; 99: 1107–1113.CrossRefGoogle ScholarPubMed
22.Mahajan, RP, Hennessy, N, Aitkenhead, AR, Jellinek, D. Effect of three different surgical prone positions on lung volumes in healthy volunteers. Anaesthesia 1994; 49: 583–586.CrossRefGoogle ScholarPubMed
23.Hedenstierna, G, Rothen, HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 2000; 16: 329–335.CrossRefGoogle Scholar
24.Walther, SM, Domino, KB, Glenny, RW, Hlastala, MP. Positive end-expiratory pressure redistributes perfusion to dependent lung regions in supine but not in prone lambs. Crit Care Med 1999; 27: 37–45.CrossRefGoogle Scholar
25.Pelosi, P, Croci, M, Ravagnan, I et al. . The effects of body mass on lung volumes, respiratory mechanics and gas exchange during general anesthesia. Anesth Analg 1998; 87: 654–660.CrossRefGoogle ScholarPubMed
26.Mure, M, Lindahl, SG. Prone position improves gas exchange – but how? Acta Anaesthesiol Scand 2001; 45: 150–159.Google Scholar
27.Radstrom, M, Loswick, AC, Bengtsson, JP. Respiratory effects of the kneeling prone position for low back surgery. Eur J Anaesthesiol 2004; 21: 279–283.CrossRefGoogle ScholarPubMed
28.Tang, Y, Turner, MJ, Baker, AB. Effects of alveolar dead-space, shunt and V/Q distribution on respiratory dead-space measurements. Br J Anaesth 2005; 95: 538–548.CrossRefGoogle ScholarPubMed