New concepts of atelectasis during general anaesthesia

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New concepts of atelectasis during general anaesthesia L Magnusson, D.R. Spahn British Journal of Anaesthesia Volume 91, Issue 1, Pages 61-72 (July 2003) DOI: 10.1093/bja/aeg085 Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 1 Examples of CT scans of a patient with healthy lungs, before and after induction of anaesthesia. The CT slices are 1 cm above the level of the right diaphragm. Arrows indicate lung densities, thought to represent atelectasis (from Rusca and colleagues84). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 2 Two-dimensional representation of a volume image from an anaesthetized subject. The surface of the lung is shown in shades of grey and atelectasis is shown in white. The anteroposterior view (top) shows the right and left lungs, with a visible cardiac shadow (arrow). The lateral view (bottom) shows the atelectatic regions in the most dependent lung (from Warner and colleagues98). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 3 Measurement of atelectatic surface by CT of the lung at the level of the interventricular septum and corresponding histograms. The total lung surface has densities between –1000 and +100 HU. Atelectatic lung surface has densities between –100 and +100 HU (from Benoît and colleagues6). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 4 Diagram of a midsagittal section of the thorax while awake (solid lines) and while anaesthetized (dashed lines). Note the alteration in the position of the diaphragm (cephalad motion in the dependent portion; from Warner and colleagues98). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 5 Time to collapse of an unventilated lung compartment. PreO2=3 min of preoxygenation. The inert gas breathed after induction was either nitrogen or nitrous oxide. Collapse occurred more quickly after preoxygenation. The greater the inspired oxygen fraction after induction, the faster the collapse. Time to collapse is largely independent of whether the inspired gas mixture after induction contains nitrogen or nitrous oxide (from Joyce and colleagues38). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 6 Samples of CT scans of a morbidly obese and a non-obese patient before anaesthesia, after extubation and 24 h later. These slices were taken at the level of the interventricular septum (from Eichenberger and colleagues19). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 7 Changes of arterial oxygen saturation (SaO2) during apnoea in children, in an obese adult and in a ‘typical’ postoperative patient compared with the ‘standard’ adult (from Farmery and colleagues20). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 8 Atelectasis before (time=0) and during the vital capacity manoeuvre. Mean values and sd (error bars) are shown. An exponential decay curve is fitted to individual data (from Rothen and colleagues77). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 9 Schematic representation of the alveolar recruitment strategy. In pressure control ventilation, the pressure amplitude of 20 cm H2O remains constant throughout the manoeuvre. Each pressure step is maintained for 1 min. After airway pressures of 40/20 cm H2O, the pressures are reduced to 30/10 cm H2O. The initial settings are then resumed. (Paw, pulmonary airway pressure; Pip, peak inspiratory pressure; from Tusman and colleagues96). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions

Fig 10 Effect of bi-level positive airway pressure (BiPAP) on FEV1. *P<0.05 compared with the other two groups (from Joris and colleagues36). British Journal of Anaesthesia 2003 91, 61-72DOI: (10.1093/bja/aeg085) Copyright © 2003 British Journal of Anaesthesia Terms and Conditions