Position and shape of the diaphragm: implications for atelectasis formation

To evaluate diaphragm movement, 18 consecutive patients undergoing surgery under general anaesthesia were allocated to Group 1 (n = 9: no neuromuscular paralysis) or Group 2 (n = 9: neuromuscular paralysis achieved with pancuronium). Spiral computerised tomography was performed awake and during anaesthesia at end-expiratory level and, additionally, in four patients (Group 2) at end-inspiration for subsequent analysis. There was a significant cephalad displacement of the most cephalad point of the diaphragm dome at functional residual capacity, particularly in its dependent portion, in the pancuronium group. During anaesthesia with no persisting muscle paralysis, there was only a minor and insignificant cephalad shift of the diaphragm dome. However, regional analysis showed that the most dorsal part of the diaphragm was significantly displaced cephalad. Compared with conscious, spontaneous breathing, mechanical ventilation decreased the inspiratory displacement of the dependent part of the muscle. This minor movement of the diaphragm may play an additional role in atelectasis formation.