Effect of continuous positive airway pressure on the measurement of thoracoabdominal asynchrony and minute ventilation in children anesthetized with sevoflurane and nitrous oxide.
OBJECTIVE
s: To quantify thoracoabdominal asynchrony (TAA) in children during anesthesia, and to measure the effect of continuous positive airway pressure (CPAP) on TAA, tidal volume (VT), and minute ventilation (E).


METHODS
Prospective, nonrandomized, controlled study.


METHODS
Operating room of a university children's hospital.


METHODS
Ninety children aged 2 to 9 years scheduled for elective outpatient day surgery who were enrolled prospectively.


METHODS
Each subject was anesthetized with sevoflurane 3% in equal parts O2 and N2O while breathing spontaneously through a facemask. Respiratory impedance plethysmography was used to calculate TAA indexes (phase angle [PA], phase relation in inspiration [PhRIB], phase relation in expiration, phase relation in total breath [PhRTB], and ratio of the inspiratory time to the total duration of the respiratory cycle [TI/TTOT]), VT, and E. Tidal gas flows were measured with a dual-hotwire anemometer with the sensor inserted between the facemask and the Y-piece of the anesthetic breathing circuit. This enabled the volume calibration of the respiratory impedance plethysmography equipment. The following conditions were compared: (1) no CPAP, (2) CPAP of 5 cm H2O, and (3) CPAP of 10 cm H2O.


RESULTS
Eighty-one children completed the study protocol. All measurements of TAA with an inspiratory component (PA, PhRIB, PhRTB, and TI/TTOT) decreased significantly from baseline with the addition of CPAP to the circuit. Application of CPAP of 10 cm H2O decreased significantly mean VTs and Es compared with CPAP of 5 cm H2O and no CPAP. There were no differences in TAA for all conditions when comparing children scheduled for adenoidectomy with other surgical procedures.


CONCLUSIONS
With spontaneously breathing anesthetized children, TAA decreases with the application of CPAP. CPAP of 5 cm H2O was as effective as CPAP of 10 cm H2O in reducing PA, PhRIB, PhRTB, and TI/TTOT. However, CPAP of 10 cm H2O also caused a significant decrease in VT and E.
Reber
Adrian
A
Division of Pediatric Anesthesia, University Children's Hospital of Basel, Basel, Switzerland. Adrian.Reber@unibas.ch
Geiduschek
Jeremy M
JM
Bobbià
Sandro A
SA
Bruppacher
Heinz R
HR
Frei
Franz J
FJ
D000556:Ambulatory Surgical Procedures; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008738:Methyl Ethers; D009609:Nitrous Oxide; D010992:Plethysmography, Impedance; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012123:Pulmonary Ventilation / Q000502:physiology*; D015656:Respiratory Mechanics / Q000502:physiology*; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide