Related Experiment Videos

Decrease of functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized

Britta S von Ungern-Sternberg1, Jürg Hammer, Andreas Schibler

  • 1Division of Anesthesia, University Children's Hospital, Roemergasse 8, CH-4005 Basel, Switzerland. bvonungern@uhbs.ch

Anesthesiology
|September 29, 2006
PubMed

Insights

Neuromuscular blockade significantly reduced functional residual capacity (FRC) and ventilation distribution in infants and children, with greater impact on infants. Positive end-expiratory pressure (PEEP) effectively restored FRC and improved ventilation homogeneity in both groups.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Pulmonary mechanics differ with age, potentially altering neuromuscular blockade effects in infants.
  • Understanding these age-dependent differences is crucial for optimizing anesthetic and ventilatory strategies.

Purpose of the Study:

  • To investigate the impact of neuromuscular blockade on functional residual capacity (FRC) and ventilation distribution in infants and preschool children.
  • To evaluate the effectiveness of positive end-expiratory pressure (PEEP) in reversing these effects.

Main Methods:

  • 14 infants (0-6 months) and 25 preschool children (2-6 years) were studied.
  • Measurements of FRC and lung clearance index were taken post-intubation, during neuromuscular blockade, and during blockade with PEEP (3 cm H2O).

Main Results:

  • Neuromuscular blockade significantly decreased FRC in both infants (21.3 to 12.2 ml/kg) and children (25.6 to 23.0 ml/kg).
  • The reduction in FRC was significantly greater in infants compared to preschool children (P < 0.001).
  • PEEP application restored FRC to baseline levels in infants and increased it above baseline in children, also improving ventilation distribution.

Conclusions:

  • Neuromuscular blockade causes substantial decreases in FRC and ventilation distribution, particularly in young infants.
  • PEEP is an effective intervention to increase FRC and restore ventilation homogeneity in anesthetized, paralyzed pediatric patients.
  • These findings support the use of PEEP in infants and children undergoing procedures requiring neuromuscular blockade.
Abstract

Related Concept Videos

Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Acute Respiratory Failure-III01:30

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without causing...
Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...