The influence of position and PEEP on arterial blood gas during operation

From December, 1990 to December, 1991, we studied the influence of PEEP and positional change to arterial blood gas in 60 ASA class II or III, aged 20 to 65 years, non-obese patients. The patients were assigned randomly into six groups. Group 1: head down position without PEEP. Group 2: head down position with PEEP 5 cmH2O. Group 3: lithotomy position without PEEP. Group 4: lithotomy position with PEEP 5 cmH2O. Group 5: supine position without PEEP. Group 6: supine position with PEEP 5 cmH2O. Blood gas analysis were performed at 5, 15, 30, 60, 120, and 180 minutes after positional change in group 1-4 and after anesthesia in group 5 and 6. The ventilator settings were: tidal volume -10 ml x 25 x (height in meters)2, rate 8/min. The results of significant difference inter-grouply were: PaO2 at 15 minutes; PaCO2 at 5 minutes; pH at 60, 120, and 180 minutes; base excess (BE) at 120 and 180 minutes. As the time progressed, PaO2 decreased in group 1, 2, and 3; PaCO2 decreased in group 3 and 5; pH decreased in group 3; BE decreased in all groups. PaCO2 were between 30-40 mmHg and no hypocarbia produced in all groups. In conclusion, ventilation of the non-obese patient based on 10 ml x 25 x (height in meters)2 x 8/min produce normocarbia and PaO2 more than 80 mmHg with 50% oxygen. No significant difference of PaO2 were found whether there were position change or PEEP 5 cmH2O.