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Respiratory variables during thoracotomy for PDA ligation

G D Puri1, S Hariwir, P Chari

  • 1Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Anaesthesia and Intensive Care
|June 1, 1996
PubMed
Summary

Physiological deadspace fraction of tidal volume (VD/VT) increased in the lateral position during patent ductus arteriosus surgery. Changes in VD/VT did not correlate with arterial oxygen tension during the procedure.

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Authors' response.

The Indian journal of medical research·2022

Area of Science:

  • Cardiothoracic Surgery
  • Anesthesiology
  • Respiratory Physiology

Background:

  • Patent ductus arteriosus (PDA) is a congenital heart defect requiring surgical intervention.
  • Posterolateral thoracotomy is a common surgical approach for PDA ligation.
  • Understanding respiratory mechanics during surgery is crucial for patient management.

Purpose of the Study:

  • To investigate changes in physiological deadspace fraction of tidal volume (VD/VT) during posterolateral thoracotomy for PDA.
  • To assess arterial to end-tidal carbon dioxide tension differences [P(a-E')CO2], arterial oxygen tension (PaO2), and respiratory system compliance.
  • To correlate VD/VT changes with PaO2 during different surgical stages.

Main Methods:

  • Twenty patients with PDA undergoing posterolateral thoracotomy under general anesthesia with controlled ventilation were studied.

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  • Measurements of VD/VT, P(a-E')CO2, PaO2, and respiratory system compliance were taken at six defined surgical stages.
  • Statistical analysis (P < 0.01, P < 0.05) was used to determine significant changes.

    • Main Results:

    • VD/VT significantly increased upon assuming the lateral posture and decreased after chest opening, then increased again post-ligation.
    • PaO2 significantly decreased after chest opening, reaching its lowest point before chest closure, and remained lower than pre-surgical levels.
    • Respiratory system compliance was lowest at stage 4 (post-ligation, pre-closure). No significant changes in P(a-E')CO2 were observed.

    Conclusions:

    • Surgical positioning and manipulation during posterolateral thoracotomy significantly alter VD/VT and PaO2 in PDA patients.
    • The observed changes in VD/VT did not favorably correspond with arterial oxygen tensions throughout the procedure.
    • Careful monitoring of respiratory parameters is essential during PDA surgery to manage potential hypoxemia and altered ventilation.