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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
Summary
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.
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