Effect of continuous positive airway pressure ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients
10.3760/cma.j.cn131073.20221012.00307
- VernacularTitle:麻醉诱导期持续气道正压通气对老年患者围术期肺不张及氧合功能的影响
- Author:
Weiwei ZHANG
1
;
Xiaopeng HE
;
Shaoyi FENG
;
Xuesen SU
;
Xin YUAN
;
Shaoshuai WANG
;
Zixuan WANG
;
Jiayu ZHU
;
Xin WANG
;
Wenjie ZHANG
;
Shouyuan TIAN
Author Information
1. 山西医科大学麻醉学院，太原 030000
- Keywords:
Continuous positive airway pressure;
Elderly;
Pulmonary atelectasis;
Oxygenation
- From:
Chinese Journal of Anesthesiology
2023;43(3):288-292
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of continuous positive airway pressure (CPAP) ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients.Methods:Forty-six elderly patients of either sex, aged 65-80 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective cerebrovascular intervention surgery under general anesthesia, were divided into 2 groups ( n=23 each) according to the random number table method: control group (group C) and CPAP ventilation group (group CPAP). During induction of anesthesia, CPAP was set at 5 cmH 2O during spontaneous breathing, and PEEP was set at 5 cmH 2O when spontaneous breathing disappeared, and the ventilation mode was changed to pressure-controlled ventilation (PCV) mode in group CPAP. CPAP was not set, and PEEP was set at 0 cmH 2O for PCV when spontaneous breathing disappeared in group C. During anesthesia maintenance, PCV-volume guaranteed mode was used in both groups, and PEEP was set at 5 cmH 2O. Whole lung CT scanning was performed immediately after radial artery catheterization (T 0), at 1 min after endotracheal intubation (T 1), and before tracheal extubation (T 2) at the end of operation to calculate the percentage of atelectasis area at 1 cm above the right diaphragm. At T 0, T 1, T 2 and 30 min after entering postanesthesia care unit (T 3), blood samples from the radial artery were taken to record PaO 2 and PaCO 2 and calculate the oxygenation index (OI). Results:Compared with the baseline at T 0, the percentage of atelectasis area was significantly increased at T 1 and T 2 in two groups ( P<0.05); PaO 2 was significantly increased at T 1 and T 2 and decreased to T 0 level at T 3, OI was decreased at T 1 and T 2 and increased to T 0 level at T 3 in two groups ( P<0.05). Compared with group C, the percentage of atelectasis area was significantly decreased and PaO 2 and OI were increased at T 1 and T 2 in group CPAP ( P<0.05). There was no significant difference in PaCO 2 at each time point between the two groups ( P>0.05). Conclusions:CPAP ventilation during induction of anesthesia can reduce the development of perioperative atelectasis and improve the oxygenation in elderly patients.
