Effects of anaesthesia on respiratory mechanics

  • G. Hedenstierna
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Anaesthesia has effects on both the mechanics of the respiratory system and pulmonary gas exchange. Thus, the respiratory system appears to be stiffer, i.e. the compliance is reduced, than in the awake state and the resistance to breathing is increased. The effects on gas exchange result in impairment of blood oxygenation and sometimes also in less efficient elimination of CO2. Several of the pioneering studies in this field were published in the 1950s [1–3]. During the forty years that have elapsed after these initial reports, there is increasing evidence that the changes in respiratory mechanics are the cause of gas exchange impairment. Thus, understanding respiratory mechanics during anaesthesia may guide in the understanding impaired gas exchange as well as in promoting techniques that counter the deterioration in gas exchange. This review will analyse the effects of anaesthesia on respiratory mechanics and the corresponding morphological correlates, and then relate gas exchange impairment to the anaesthesia-induced mechanical and morphological changes.


Lung Volume Functional Residual Capacity Respiratory Mechanic Recruitment Manoeuvre Muscle Paralysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nims KG, Conner EH, Comroe JH (1955) The compliance of the human thorax in anesthetized patients. J Clin Invest 34:744–750PubMedCrossRefGoogle Scholar
  2. 2.
    Campbell RJM, Nunn JF, Peckett BW (1958) A comparison of artificial ventilation and spontaneous respiration with particular reference to ventilation-blood flow relationships. Br J Anaesth 30:166–175PubMedCrossRefGoogle Scholar
  3. 3.
    Severinghaus JW, Stupfel M (1957) Alveolar dead space as an index of distribution of blood flow in pulmonary capillaries. J Appl Physiol 10:335–348PubMedGoogle Scholar
  4. 4.
    Don H (1977) The mechanical properties of the respiratory system during anesthesia. Int Anesthesiol Clin 15:113–136PubMedCrossRefGoogle Scholar
  5. 5.
    Westbrook PR, Stubbs SE, Sessler AD et al (1973) Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man. J Appl Physiol 34:81–86PubMedGoogle Scholar
  6. 6.
    Rehder K, Sessler AD, Marsh HM (1975–1976) General anesthesia and the lung. In: Murray JF (ed) Lung disease state of the art. American Lung Association, New York, pp 367–389Google Scholar
  7. 7.
    Gattinoni L, Pesenti A, Avalli L et al (1987) Pressure volume curve of the total respiratory system in acute respiratory failure. Am Rev Respir Dis 136:730–736PubMedCrossRefGoogle Scholar
  8. 8.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hogman M, Hedenstierna G (1995) Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology 82:832–842PubMedCrossRefGoogle Scholar
  9. 9.
    Wirtz H, Schmidt M (1992) Ventilation and secretion of pulmonary surfactant. Clin Invest Med 70:3–13CrossRefGoogle Scholar
  10. 10.
    Don HF, Wahba M, Cuadrado L, Kelkar H (1970) The effect of anesthesia and 100% oxygen on the functional residual capacity of the lungs. Anesthesiology 32:521–529PubMedCrossRefGoogle Scholar
  11. 11.
    Froese AB, Bryan CH (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255PubMedCrossRefGoogle Scholar
  12. 12.
    Reber A, Nylund U, Hedenstierna G (1998) Position and shape of the diaphragm: Implications for atelectasis formation. Anaesthesia (in press)Google Scholar
  13. 13.
    Krayer S, Rehder K, Vettermann J, Didier EP, Ritman EL (1989) Position and motion of the human diaphragm during anesthesia-paralysis. Anesthesiology 70:891–898PubMedCrossRefGoogle Scholar
  14. 14.
    Warner DO, Warner MA, Ritman EL (1995) Human chest wall function while awake and during halothane anesthesia. I. Quiet breathing. Anesthesiology 82:6–19PubMedCrossRefGoogle Scholar
  15. 15.
    Wahba RWM (1991) Perioperative functional residual capacity. Can J Anaesth 38: 384–400PubMedCrossRefGoogle Scholar
  16. 16.
    Hedenstierna G, Strandberg Ä, Brismar B, Lundquist H, Svensson L, Tokics L (1985) Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology 62:247–254PubMedCrossRefGoogle Scholar
  17. 17.
    Milic-Emili J, Henderson JAM, Dolovich MB et al (1966) Regional distribution of inspired gas in the lung. J Appl Physiol 21:749–759PubMedGoogle Scholar
  18. 18.
    Don HF, Wahba WM, Craig DB (1972) Airway closure, gas trapping and the functional residual capacity during anesthesia. Anesthesiology 36:533–539PubMedCrossRefGoogle Scholar
  19. 19.
    Juno P, Marsh M, Knopp TJ et al (1977) Closing capacity in awake and anesthetized- paralyzed man. J Appl Physiol 44:238–244Google Scholar
  20. 20.
    Bergman NA, Tien YK (1983) Contribution of the closure of pulmonary units to impaired oxygenation during anesthesia. Anesthesiology 59:395–401PubMedCrossRefGoogle Scholar
  21. 21.
    Dueck R, Prutow RJ, Davies NJ, Clausen JL, Davidson TM (1988) The lung volume at which shunting occurs with inhalation anesthesia. Anesthesiology 69:854–861PubMedCrossRefGoogle Scholar
  22. 22.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1988) Airway closure, atelectasis and gas exchange during general anaesthesia. Brit J Anaesth (in press)Google Scholar
  23. 23.
    Damgaard Pedersen K, Qvist T (1980) Pediatric pulmonary CT-scanning Anaesthesia- induced changes. Pediatr Radiol 9:145–148CrossRefGoogle Scholar
  24. 24.
    Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L (1985) Pulmonary densities during anesthesia with muscular relaxation: a proposal of atelectasis. Anesthesiology 62:422–428PubMedCrossRefGoogle Scholar
  25. 25.
    Lundquist H, Hedenstierna G, Strandberg A, Tokics L, Brismar B (1995) CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol 36:626–632PubMedCrossRefGoogle Scholar
  26. 26.
    Strandberg A, Tokics L, Brismar B, Lundquist H, Hedenstierna G (1986) Atelectasis during anaesthesia and in the postoperative period. Acta Anaesthesiol Scand 30:154–158PubMedCrossRefGoogle Scholar
  27. 27.
    Reber A, Engberg G, Sporre B, Kviele L, Rothen HU, Wegenius G, Nylund U, Hedenstierna G (1996) Volumetric analysis of aeration in the lungs during general anaesthesia. Br J Anaesth 76:760–766PubMedCrossRefGoogle Scholar
  28. 28.
    Tokics L, Strandberg A, Brismar B, Lundquist H, Hedenstierna G (1987) Computerized tomography of the chest and gas exchange measurements during ketamine anaesthesia. Acta Anaesthesiol Scand 31:684–692PubMedCrossRefGoogle Scholar
  29. 29.
    Shulman D, Beardsmore CS, Aronson HB, Godfrey S (1985) The effect of ketamine on the functional residual capacity in young children. Anesthesiology 62:551–556PubMedCrossRefGoogle Scholar
  30. 30.
    Nunn JF (1993) Applied respiratory physiology, 4th edn. Butterworths, Oxford, p 43–44Google Scholar
  31. 31.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795PubMedCrossRefGoogle Scholar
  32. 32.
    Morimoto S, Takeuchi N, Imanaka H, Nishimura M, Takezawa J, Taenaka N, Matsuura N, Tomoda K, Ikezoe J, Arisawa J et al (1989) Gravity-dependent atelectasis. Radiologic, physiologic and pathologic correlation in rabbits on high-frequency oscillation ventilation. Invest Radiol 24:522–530PubMedCrossRefGoogle Scholar
  33. 33.
    Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B (1994) Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 80:751–760PubMedCrossRefGoogle Scholar
  34. 34.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G (1995) Prevention of atelectasis during general anaesthesia. Lancet 345:1387–1391PubMedCrossRefGoogle Scholar
  35. 35.
    Reber A, Engberg G, Wegenius G, Hedenstierna G (1996) Lung aeration. The effect of pre-oxygenation and hyperoxygenation during total intravenous anaesthesia. Anaesthesia 51:733–737PubMedGoogle Scholar
  36. 36.
    Burger EJ, Macklem P (1986) Airway closure: demonstration by breathing 100% O2 at low lung volumes and by N2 washout. J Appl Physiol 25:139–148Google Scholar
  37. 37.
    Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H (1987) Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology 66:157–167PubMedCrossRefGoogle Scholar
  38. 38.
    Tokics L, Hedenstierna G, Svensson L, Brismar B, Cederlund T, Lundquist H, Strandberg Ä (1996) V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans. J Appl Physiol 81:1822–1833PubMedGoogle Scholar
  39. 39.
    Gunnarsson L, Tokics L, Gustavsson H, Hedenstierna G (1991) Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. Br J Anaesth 66:423–432PubMedCrossRefGoogle Scholar
  40. 40.
    Nunn JF, Bergman NA, Coleman AJ (1965) Factors influencing the arterial oxygen tension during anaesthesia with artificial ventilation. Br J Anaesth 37:898–914PubMedCrossRefGoogle Scholar
  41. 41.
    Hewlett AM, Hulands GH, Nunn JF, Milledge JS (1974) Functional residual capacity during anaesthesia III: artificial ventilation. Br J Anaesth 46:495–503PubMedCrossRefGoogle Scholar
  42. 42.
    West JB (1977) State of the art: ventilation-perfusion relationships. Am Rev Respir Dis 116:919–943PubMedGoogle Scholar
  43. 43.
    Reber A (1998) Lung aeration and pulmonary gas exchange during general and epidural anaesthesia. Acta Universitatis Upsaliensis 756:18Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1999

Authors and Affiliations

  • G. Hedenstierna

There are no affiliations available

Personalised recommendations