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New Insights into Mechanical Ventilation During Paediatric Anaesthesia

  • J. O. C. AulerJr.
  • D. Fantoni
  • M. H. C. Pereira
Conference paper

Abstract

Perioperative ventilation of small children submitted to major surgery has always been a challenge to anaesthesiologists. Most of the difficulties are related to the anaesthetic equipment itself which should be simultaneously able to ventilate the lungs correctly and at the same time deliver inhaled anaesthetics agents. Personal experience and knowledge of the peculiarities of the respiratory system of small children are also important. The natural problems involving superior airway assessment are not the main subject of this chapter. Our purpose is to present a brief review of the main differences between the respiratory system of children and adults, relevant anaesthetic practice, as well as the traditional paediatric breathing circuits employed routinely to administer inhalation agents and promote adequate gas exchange. After that, our discussion will be centred on the real benefit of new ventilatory modalities, available in modern work-station anaesthesia machines, such as pressure-controlled ventilation, low flow anaesthesia, and closed breathing circuits.

Keywords

Chest Wall Tidal Volume Lung Volume Functional Residual Capacity Peak Inspiratory Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Muller NL, Bryan AC (1979) Chest wall mechanics and respiratory muscles in infants. Pediatric Clin North Am 26 (3): 503–516Google Scholar
  2. 2.
    Keens TG, Ianuzzo CD (1979) Development of fatigue resistant muscle fibers in human ventilatory musculature. Am Rev Resp Dis[Suppl]119: 139–141Google Scholar
  3. 3.
    Lopes J, Muller NL, Bryan MH et al (1981) Importance of inspiratory muscle tone in maintenance of FRC in the newborn. J Appl Physiol 51: 830–834PubMedGoogle Scholar
  4. 4.
    Henderson-Smart DJ, Read DJC (1979) Reduced lung volume during behavioral active sleep in the newborn. J Appl Physiol 46: 1081–1085PubMedGoogle Scholar
  5. 5.
    Fisher JB, Carlo AW, Doershuk CF (1990) Pulmonary function from infancy through adolescence. In: Scarpelli ME (ed) 2’ edn Pulmonary physiology. Lea & Febiger, Philadelphia New York, pp 421–445Google Scholar
  6. 6.
    Nelson NM (1966) Neonatal pulmonary function. Pediatric Clin North Am 13 (3): 769–799Google Scholar
  7. 7.
    Klaus MH, Tooley WH, Weaver KH et al (1962) Lung volume in the newborn infant. Pediatrics 30: 111–116PubMedGoogle Scholar
  8. 8.
    Gerhardt T, Bancalari E (1981) Maturational changes of reflexes influencing inspiratory timing of newborns. J Appl Physiol 50: 1282–1285PubMedGoogle Scholar
  9. 9.
    Gerhardt T, Bancalari E (1980) Chest wall compliance in full-term and premature infants. Acta Paediatric Scand 69: 359–364CrossRefGoogle Scholar
  10. 10.
    Chu JS, Dawson P, Klaus M et al (1964) Lung compliance and lung volume measured concurrently in normal full term and premature infants. Pediatrics 34: 525–532PubMedGoogle Scholar
  11. 11.
    Doershuk CF, Fisher BJ, Matthews LW (1974) Specific airway resistance from the perinatal period into adulthood. Am Ver Resp Dis 109: 452–457Google Scholar
  12. 12.
    Conway CM (1985) Anaesthetic breathing systems. Brit J Anaesth 57: 649–657PubMedCrossRefGoogle Scholar
  13. 13.
    Cotter SM, Petros AJ, Dore CJ et al (1991) Low flow-anaesthesia practice, cost implications and acceptability. Anesthesia 46: 1009–1012CrossRefGoogle Scholar
  14. 14.
    Meakin G, Jennings AD, Beatty PCW et al (1992) Fresh gas requirements of an enclosed afferent reservoir breathing system during controlled ventilation in children. British J Anaesth 68: 43–47CrossRefGoogle Scholar
  15. 15.
    Mushin WW, Jones PL (eds) (1987) Physics for the anesthetist. 4th edn. Blackwell Scientific, Boston New York, p 375Google Scholar
  16. 16.
    Badgwell JM, Swan J, Foster AC (1996) Volume controlled ventilation made possible in infants by using compliant breathing circuits with large compression volume. Anesth Analg 82: 719–723PubMedGoogle Scholar
  17. 17.
    Stevenson GW, Tobin MJ, Horn BJ et al (1998) The effect of circuit compliance on delivered ventilation with use of an adult system for time cycled controlled ventilation using an infant lung model. Paediatric Anaesth 8 (2): 139–144CrossRefGoogle Scholar
  18. 18.
    Tobin MJ, Stevenson SW, Horn JH et al (1998) Anesth Analg 87: 766–771PubMedGoogle Scholar
  19. 19.
    Lockwood GG (1994) Techniques of mechanical ventilation in closed and low flow systems. Anesth Intensive Care 22: 419–425Google Scholar
  20. 20.
    Baker AB (1994) Low flow and closed circuits. Anesth Intensive Care 22: 341–342Google Scholar
  21. 21.
    Simionescu R (1986) Safety of low flow anesthesia. Circulation 3: 7–9Google Scholar
  22. 22.
    Igarashi M, Watanabe H, Iwasaki H et al (1999) Clinical evaluation of low-flow sevofluorane anaesthesia for paediatric patients. Acta Anesth Scand 43: 19–23CrossRefGoogle Scholar
  23. 23.
    Perez-Fontan JJ, Heldt GP, Gregory GG (1985) The effect of a gas leak around the endotracheal tube on the mean tracheal pressure during mechanical ventilation. Am Rev Respir Dis 132: 339–342PubMedGoogle Scholar
  24. 24.
    Smith RM (1980) Anesthesia for infants and children. 4th edn. CV Mosby, St Louis, pp 128–151Google Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • J. O. C. AulerJr.
  • D. Fantoni
  • M. H. C. Pereira

There are no affiliations available

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