Effects of prone position on alveolar dead space and gas exchange during general anaesthesia in surgery of long duration.
OBJECTIVE
We investigated the effects of prone position on respiratory dead space and gas exchange in 14 anaesthetized healthy patients undergoing elective posterior spinal surgery of more than 3 h of duration.


METHODS
The patients received a total intravenous anaesthetic with propofol/remifentanil/cisatracurium. They were ventilated at a tidal volume of 8-10 mL kg(-1), zero positive end-expiratory pressure and an inspired oxygen fraction of 0.4. Physiological, airway and alveolar dead spaces were calculated by analysis of the volumetric capnography waveform. Measurements were made in supine position (20 min after the beginning of mechanical ventilation) and 30, 120 and 180 min after turning to prone position.


RESULTS
We found that the alveolar dead space/tidal volume ratio did not change. PaO(2)/F(i)O(2) increased, although not statistically significantly. Dynamic compliance was reduced due to a reduction in tidal volume and an increase in plateau pressure.


CONCLUSIONS
Patients undergoing surgery in prone position for a duration of 3 h under general anaesthesia including muscle relaxation and mechanical ventilation without positive end-expiratory pressure have stable haemodynamics and no significant changes in the alveolar dead space to tidal volume ratio. Oxygenation tended to improve.
Soro
M
M
Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain.
García-Pérez
M L
ML
Belda
F J
FJ
Ferrandis
R
R
Aguilar
G
G
Tusman
G
G
Gramuntell
F
F
D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives; D019296:Capnography / Q000379:methods; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage; D016684:Prone Position / Q000502:physiology; D015742:Propofol / Q000008:administration & dosage; D011650:Pulmonary Alveoli; D011659:Pulmonary Gas Exchange; D012016:Reference Values; D000077208:Remifentanil; D012121:Respiration, Artificial; D012126:Respiratory Dead Space; D013131:Spine / Q000601:surgery*; D016683:Supine Position / Q000502:physiology; D013990:Tidal Volume; D013995:Time; D013997:Time Factors
D018686:Anesthetics, Intravenous; D009466:Neuromuscular Blocking Agents; D010880:Piperidines; D001279:Atracurium; D000077208:Remifentanil; C101584:cisatracurium; D015742:Propofol