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Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants: A prospective
Sang-Hwan Ji1, Hwan Suk Jang, Young-Eun Jang
1From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (S-HJ, HSJ, Y-EJ, E-HK, J-HL, J-TK, H-SK) and Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (J-TK, H-SK).
Insights
Maintaining spontaneous ventilation during pediatric anesthesia induction significantly reduces infant atelectasis. This method is particularly effective in preventing lung collapse in dependent areas.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Medical Imaging
Background:
- Atelectasis is a common complication during general anesthesia induction in infants.
- Infant lungs are particularly susceptible to collapse due to their smaller size and different respiratory mechanics.
Purpose of the Study:
- To investigate the efficacy of maintaining spontaneous ventilation in preventing atelectasis during anesthetic induction in infants.
- To compare atelectasis formation between spontaneous and positive-pressure ventilation techniques.
Main Methods:
- A randomized controlled study was conducted with 60 infants under one year of age undergoing general anesthesia.
- Patients were randomly assigned to either maintain spontaneous ventilation or receive manual positive-pressure ventilation during preoxygenation.
- Lung ultrasound was used to assess atelectasis formation after preoxygenation.
Main Results:
- Atelectasis occurred in 26.9% of infants in the spontaneous ventilation group versus 73.3% in the controlled (positive-pressure) group (P=0.001).
- The relative risk of atelectasis was significantly lower (0.39) in the spontaneous ventilation group.
- Ultrasound scores for consolidation in dependent lung regions were significantly lower in the spontaneous ventilation group.
Conclusions:
- Maintaining spontaneous ventilation during general anesthesia induction effectively prevents atelectasis in infants.
- This technique is especially beneficial for protecting the dependent portions of the lungs.
- Spontaneous ventilation represents a valuable strategy to improve respiratory outcomes in pediatric anesthesia.
Background:
Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants.
Objectives:
We hypothesised that maintaining spontaneous ventilation can reduce atelectasis formation during anaesthetic induction in infants. We compared spontaneous ventilation and manual positive-pressure ventilation in terms of atelectasis formation in infants.
Design:
Randomised controlled study.
Setting:
Single tertiary hospital in Seoul, Republic of Korea, from November 2018 to December 2019.
Patients:
We enrolled 60 children younger than 1 year of age undergoing general anaesthesia, of whom 56 completed the study. Exclusion criteria were history of hypoxaemia during previous general anaesthesia, development of a respiratory tract infection within 1 month, current intubation or tracheostomy cannulation, need for rapid sequence intubation, preterm birth, age within 60 weeks of the postconceptional age and the presence of contraindications for rocuronium or sodium thiopental.
Intervention:
Patients were allocated randomly to either the 'spontaneous' group or 'controlled' group. During preoxygenation, spontaneous ventilation was maintained in the 'spontaneous' group while conventional bag-mask ventilation was provided in the 'controlled' group. After 5 min of preoxygenation, a lung ultrasound examination was performed to compare atelectasis formation in the two groups.
Results:
Atelectasis after preoxygenation was seen in seven (26.9%) of 26 patients in the 'spontaneous' group and 22 (73.3%) of 30 patients in the 'controlled' group (P = 0.001). The relative risk of atelectasis in the 'spontaneous' group was 0.39 (95% CI 0.211 to 0.723). Regarding ultrasound pictures of consolidation, the total score and sum of scores in the dependent regions were significantly lower in the 'spontaneous' group than in the 'controlled' group (P = 0.007 and 0.001, respectively).
Conclusion:
Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age, particularly in the dependent portions of the lungs.
Trial Registration:
Clinicaltrials.gov (identifier: NCT03739697).
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