Document Detail

Decrease of functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized young infants and preschool children.
MedLine Citation:
PMID:  17006063     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Based on age-dependent differences in pulmonary mechanics, the effect of neuromuscular blockade may differ in infants compared with older children. The aim of this study was to determine the impact of neuromuscular blockade and its reversal by positive end-expiratory pressure (PEEP) on functional residual capacity (FRC) and ventilation distribution in young infants and preschool children. METHODS: The authors studied 14 infants (aged 0-6 months) and 25 preschool children (aged 2-6 yr). FRC and lung clearance index were calculated. Measurements were taken (1) after intubation, (2) during neuromuscular blockade, and (3) during neuromuscular blockade plus application of PEEP (3 cm H2O). RESULTS: Functional residual capacity (mean +/- SD) decreased from 21.3 +/- 4.7 ml/kg to 12.2 +/- 4.8 ml/kg (P < 0.001) during neuromuscular blockade in infants and from 25.6 +/- 5.9 ml/kg to 23.0 +/- 5.3 ml/kg (P < 0.001) in preschool children. With the application of PEEP, FRC increased to 22.3 +/- 5.9 ml/kg (P = 0.4829, compared with baseline) in infants and 28.2 +/- 5.8 ml/kg (P < 0.001) in children. The lung clearance index increased after neuromuscular blockade, whereas baseline values were regained after the application of PEEP. The changes induced by neuromuscular blockade were significantly greater in infants compared with preschool children (P < 0.001). CONCLUSIONS: Although the use of neuromuscular blockade decreased FRC and ventilation distribution substantially in both groups, the changes were more pronounced in young infants. With PEEP, FRC increased and ventilation homogeneity was restored. These results provide a rationale to use PEEP in anesthetized, paralyzed infants and children.
Britta S von Ungern-Sternberg; Jürg Hammer; Andreas Schibler; Franz J Frei; Thomas O Erb
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  105     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-28     Completed Date:  2006-11-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  670-5     Citation Subset:  AIM; IM    
Division of Anesthesia, University Children's Hospital, Roemergasse 8, CH-4005 Basel, Switzerland.
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MeSH Terms
Child, Preschool
Functional Residual Capacity / physiology*
Neuromuscular Blockade*
Positive-Pressure Respiration
Respiration, Artificial
Respiratory Function Tests
Respiratory Mechanics / physiology*
Sample Size

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