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Related Experiment Videos

Pressure-supported ventilation for posterior fossa operation.

N Mori1, H Takahashi, T Yanase

  • 1Department of Anesthesiology, Akita University School of Medicine, Akita, Japan.

Journal of Neurosurgical Anesthesiology
|March 1, 1990
PubMed
Summary

Pressure-supported ventilation (PSV) effectively maintained gas exchange during posterior fossa surgery. Spontaneous breathing monitored brainstem function, with ventilator alarms detecting early surgical impacts.

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Respiratory Physiology

Background:

  • Maintaining adequate gas exchange is crucial during posterior fossa operations.
  • Spontaneous respiration can serve as a real-time indicator of brainstem function.
  • Pressure-supported ventilation (PSV) offers a potential method to support breathing while allowing spontaneous efforts.

Purpose of the Study:

  • To evaluate the efficacy of PSV in maintaining adequate ventilation during posterior fossa surgery.
  • To assess the utility of spontaneous respiration as a monitor of brainstem integrity under PSV.
  • To determine the sensitivity of ventilator alarms in detecting early signs of brainstem compromise.

Main Methods:

  • Twelve healthy patients undergoing posterior fossa surgery were studied.

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  • Ventilation was switched from controlled mode to PSV (Servo 900C) after dural opening.
  • Spontaneous respiration was triggered with a low negative inspiratory pressure; supporting pressures ranged from 4-20 cm H2O.
  • Ventilatory parameters (frequency, tidal volume, minute volume, end-tidal CO2) were continuously monitored.

    • Main Results:

    • PSV successfully maintained adequate ventilation, with PaCO2 levels between 31.7-45.9 mm Hg.
    • Two instances of apnea occurred during brainstem manipulation, immediately detected by ventilator alarms.
    • No postoperative signs of brainstem dysfunction were observed in any patients.

    Conclusions:

    • Pressure-supported ventilation is effective for maintaining adequate gas exchange during posterior fossa surgery.
    • Spontaneous respiration under PSV serves as a reliable indicator of normal brainstem function.
    • The integrated alarm system of the ventilator is highly sensitive for early detection of surgical insults to the brainstem.