title: Constant positive airway pressure reduces hypoventilation induced by inhalation anesthesia.
abstract: OBJECTIVE
  To discover if reducing respiratory system impedance would increase tidal volume and improve ventilation during inhalation anesthesia.
  
  
  METHODS
  Prospective, randomized cross-over study.
  
  
  METHODS
  Nine ASA physical status I and II adult female oncology patients undergoing breast operations with or without lymph node dissection and general anesthesia while breathing spontaneously.
  
  
  METHODS
  Patients underwent alternating trials of constant positive airway pressure, with or without pressure support. Constant positive airway pressure and pressure support were titrated to maximize respiratory system compliance and equal inspiratory pressure gradient across tracheal tube, respectively. Variables reflecting cardiovascular function, pulmonary mechanics and lung gas exchange, and respired gases and isoflurane concentrations were measured.
  
  
  RESULTS
  End-tidal concentration of isoflurane (1.3 +/- 0.2%), Fio(2) (0.43 +/- 0.09 ), and CO(2) elimination (209 +/- 42 mL min(-1)) was unchanged throughout study in patients aged 63 +/- 12 years, weighing 72 +/- 12 kg. Constant positive airway pressure (12 +/- 2 cm H(2)O) increased respiratory system compliance from 52 +/- 8 to 80 +/- 9 mL cm H(2)O(-1) (P < .001), tidal volume from 156 +/- 32 to 325 +/- 52 mL (P < .001), and minute ventilation from 4.37 +/- 0.86 to 6.18 +/- 0.92 L min(-1) (P < .001). Respiratory rate decreased from 29 +/- 7 to 19 +/- 2 min(-1) (P < .001), Paco(2) decreased from 54 +/- 8 to 44 +/- 6 mm Hg (P < .001), and Pao(2) increased from 137 +/- 37 to 160 +/- 64 mm Hg (P < .001). Pressure support (3.1 +/- 0.3 cm H(2)O) did not alter ventilation or gas exchange.
  
  
  CONCLUSIONS
  We conclude that constant positive airway pressure titrated to optimal respiratory system compliance will increase efficiency of inspiratory muscles and improve ventilation. Constant positive airway pressure facilitates a pattern of breathing that minimizes some of the adverse pulmonary effects of inhalation anesthesia.
authors.affiliation: Department of Anesthesiology, University of South Florida College of Medicine, Tampa, FL 33612-4799, USA. rsmith@hsc.usf.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Smith
authors.forename: Edward C
authors.initials: EC
authors.lastname: Bratzke
authors.forename: Rafael V
authors.initials: RV
authors.lastname: Miguel
mesh_terms: D000368:Aged; D000403:Airway Resistance / Q000502:physiology; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery; D018592:Cross-Over Studies; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000139:chemically induced* / Q000628:therapy*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D012132:Respiratory Muscles / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology
chemical_list: D010100:Oxygen