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Effects of prone position on alveolar dead space and gas exchange during general anaesthesia in surgery of long duration

Published online by Cambridge University Press:  01 May 2007

M. Soro ,
M. L. García-Pérez ,
F. J. Belda ,
R. Ferrandis ,
G. Aguilar ,
G. Tusman  and
F. Gramuntell
M. Soro
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
M. L. García-Pérez
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
F. J. Belda*
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
R. Ferrandis
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
G. Aguilar
Affiliation:
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
G. Tusman
Affiliation:
Hospital Privado de Comunidad, Department of Anaesthesia, Mar del Plata, Argentina
F. Gramuntell
Affiliation:
Hospital Arnau de Vilanova, Department of Anaesthesia and Critical Care, Valencia, Spain
*
Correspondence to: F. Javier Belda, Department of Anesthesia and Critical Care, Hospital Clinico Universitario, Avenida Blasco Ibanez, 17. 46010 Valencia, Spain. E-mails: fjbelda@uv.es, geragu68@hotmail.com; Tel: +34 963862653; Fax: +34 963862644
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Summary

Background and objective

We investigated the effects of prone position on respiratory dead space and gas exchange in 14 anaesthetized healthy patients undergoing elective posterior spinal surgery of more than 3 h of duration.

Methods

The patients received a total intravenous anaesthetic with propofol/remifentanil/cisatracurium. They were ventilated at a tidal volume of 8–10 mL kg−1, zero positive end-expiratory pressure and an inspired oxygen fraction of 0.4. Physiological, airway and alveolar dead spaces were calculated by analysis of the volumetric capnography waveform. Measurements were made in supine position (20 min after the beginning of mechanical ventilation) and 30, 120 and 180 min after turning to prone position.

Results

We found that the alveolar dead space/tidal volume ratio did not change. PaO2/FiO2 increased, although not statistically significantly. Dynamic compliance was reduced due to a reduction in tidal volume and an increase in plateau pressure.

Conclusions

Patients undergoing surgery in prone position for a duration of 3 h under general anaesthesia including muscle relaxation and mechanical ventilation without positive end-expiratory pressure have stable haemodynamics and no significant changes in the alveolar dead space to tidal volume ratio. Oxygenation tended to improve.

Keywords

RESPIRATORY DEAD SPACEPULMONARY GAS EXCHANGEPRONE POSITIONSURGERYLONG DURATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 431 - 437
Copyright
Copyright © European Society of Anaesthesiology 2006

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