Airway closure during anesthesia: a comparison between resident-gas and argon-bolus techniques

Airway closure was measured in awake and then anesthetized supine healthy subjects with the argon-bolus and the resident-gas (nitrogen) techniques simultaneously. The preinspiratory lung volume for the closing volume maneuver was varied from residual volume to closing capacity (CC). Comparative measurements were also performed in the upright and supine positions in awake subjects. Closing volume (CV) was consistently larger with the bolus technique in supine subjects both when awake and when anesthetized (difference between methods 0.1--0.2 l, P less than 0.01), whereas no difference between the methods was noted in upright subjects. The lower "nitrogen CV" in supine subjects may be due to a shorter vertical lung height with a smaller range of nitrogen concentrations, resulting in a less abrupt onset of phase IV (taken to indicate CV). CV was not significantly affected by the preinspiratory lung volume with either technique, and CC was unchanged when anesthesia was instituted. Functional residual capacity (FRC) was reduced with anesthesia (mean reduction: 0.6 l, P less than 0.01) and FRC-CC became negative in all subjects with either technique. This implies intermittent or continuous airway closure during anesthesia and the possibility of increased venous admixture.