Abstract
This review examines the possible mechanisms for the impairment in pulmonary gas exchange and ventilatory control associated with general anaesthesia. Venous admixture and physiological dead space are both increased during anaesthesia. These changes result from increased ventilation-perfusion inequality, an effect apparently mainly attributable to alteration in the intrapulmonary distribution of ventilation. Concomitantly, with these changes in pulmonary gas exchange anaesthesia is known to alter the mechanics of the respiratory system and, in particular, to decrease functional residual capacity in recumbent subjects. Recent research has renewed interest in the finding that anaesthesia also alters chest wall shape and motion. This review attempts to synthesize the available and increasing evidence which supports the hypothesis that anaesthesia-induced alterations in chest wall behavior are responsible for the associated changes in lung function and consequent impairment of pulmonary gas exchange. Finally, the important finding that anaesthetic agents depress the ventilatory response to hypercapnia and hypoxia is discussed.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Agostoni E (1972) Mechanics of the pleural space. Physiol Rev 52:57–128
Askrog V (1966) Changes in (a-A)CO2 difference and pulmonary artery pressure in anesthetized man. J Appl Physiol 21:1299–1305
Aviado DM (1975) Regulation of bronchomotor tone during anesthesia. Anesthesiology 42:68–80
Bendixen HH, Hedley-Whyte J, Laver MB (1963) Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. A concept of atelectasis. N Engl J Med 269:991–996
Benumof JL, Wahrenbrock EA (1975) Blunted hypoxic pulmonary vasoconstriction by increased lung vascular pressures. J Appl Physiol 38:846–850
Bergman NA (1970) Pulmonary diffusing capacity and gas exchange during halothane anesthesia. Anesthesiology 32:317–324
Bjertnaes LJ, Hauge A, Nakken KF, Bredesen JE (1976) Hypoxic pulmonary vasoconstriction: inhibition due to anesthesia. Acta Physiol Scand 96:283–285
Brendstrup A (1966) The effect of artificial respiration on the regional distribution of ventilation examined with xenon-133. Acta Anaesth Scand [Suppl] 23:180–186
Briscoe WA, DuBois AB (1958) The relationship between airway resistance, airway conductance and lung volume in subjects of different age and body size. J Clin Invest 37:1279–1285
Campbell EJM, Nunn JF, Peckett BW (1958) A comparison of arterial ventilation and spontaneous respiration with particular reference to ventilation-bloodflow relationships. Br J Anaesth 36:166–175
Cheney FW, Colley PS (1980) The effect of cardiac output on arterial blood oxygenation. Anesthesiology 52:496–503
Derenne J-P, Couture J, Iscoe S, Whitelaw WA, Milic-Emili J (1976) Occlusion pressures in men rebreathing CO2 under methoxyflurane anesthesia. J Appl Physiol 40:805–814
Déry R, Pelletier J, Jacques A, Clavet M, Honde J (1965) Alveolar collapse induced by denitrogenation. Can Anaesth Soc J 12:531–544
Don HF, Wahba M, Cuadrado L, Kelkar K (1970) The effects of anesthesia and 100 per cent oxygen on the functional residual capacity of the lungs. Anesthesiology 32:521–529
Dueck R, Young I, Clausen J, Wagner PD (1980) Altered distribution of pulmonary ventilation and blood flow following induction of inhalational anesthesia. Anesthesiology 52:113–125
Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255
Fukuma S, Wildeboer-Venema FN, Horie S, Yokota H, Honda Y, Schuurmans Stekhaus JH, Kreuzer F (1970) Pulmonary diffusing capacity in the dog as influenced by anesthesia and ventilatory regime. Respir Physiol 8:311–331
Gilmour I, Burnham M, Craig DB (1976) Closing capacity measurement during general anesthesia. Anesthesiology 45:477–482
Grassino AE, Anthonisen NR (1975) Chest wall distortion and regional lung volume distribution in erect humans. J Appl Physiol 39:1004–1007
Grimby G, Hedenstierna G, Löfström B (1975) Chest wall mechanics during artificial ventilation. J Appl Physiol 38:576–580
Hedenstierna G, McCarthy G (1975) Mechanics of breathing, gas distribution and functional residual capacity at different frequencies of respiration during spontaneous and artificial ventilation. Br J Anaesth 47:706–711
Hedenstierna G, McCarthy G, Bergström M (1976) Airway closure during mechanical ventilation. Anesthesiology 44:114–123
Hewlett AM, Hulands GH, Nunn JF, Heath JF (1974) Functional residual capacity during anaesthesia. II: Spontaneous respiration. Br J Anaesth 46:486–494
Hewlett AM, Hulands GH, Nunn JF, Milledge JS (1974) Functional residual capacity during anaesthesia. III: Artificial ventilation. Br J Anaesth 46:495–503
Hickey RF, Visick WD, Fairley HB, Fourcade HE (1973) Effects of halothane anesthesia on functional residual capacity and alveolar-arterial oxygen tension difference. Anesthesiology 38:20–24
Hirshman CA, Bergman NA (1978) Halothane and enflurane protect against bronchospasm in asthma dog model. Anesth Analg 57:629–633
Johnson SR (1951) The effect of some anaesthetic agents on the circulation in man, with special reference to the significance of pulmonary blood volume for the circulatory regulation. Acta Chir Scand [Suppl] 158:1–143
Jones JG, Faithfull D, Jordan C, Minty B (1979) Rib cage movement during halothane anaesthesia in man. Br J Anaesth 51:399–406
Juno P, Marsh HM, Knopp TJ, Rehder K (1978) Closing capacity in awake and anesthetized-paralyzed man. J Appl Physiol Respir Environ Exercise Physiol 44:238–244
Kelman GR, Nunn JF, Prys-Roberts C, Greenbaum R (1967) The influence of cardiac output on arterial oxygenation: a theoretical study. Br J Anaesth 39:450–457
Knill RL, Bright S, Manninen P (1978) Hypoxic ventilatory responses during thiopentone sedation and anaesthesia in man. Can Anaesth Soc J 25:366–372
Knill RL, Gelb AW (1978) Ventilatory responses to hypoxia and hypercapnia during halothane sedation and anesthesia in man. Anesthesiology 49:244–251
Knill RL, Manninen PH, Clement JL (1979) Ventilation and chemoreflexes during enflurane sedation and anaesthesia in man. Can Anaesth Soc J 26:353–360
Landmark SJ, Knopp TJ, Rehder K, Sessler AD (1977) Regional pulmonary perfusion and\(\mathop V\limits^ \bullet \)/Q in awake and anesthetized-paralyzed man. J Appl Physiol: Respir Environ Exercise Physiol 43:993–1000
Marshall BE, Cohen PJ, Klingenmaier CH, Aukberg S (1969) Pulmonary venous admixture before, during and after halothane: oxygen anesthesia in man. J Appl Physiol 27:653–657
Marshall BE, Wyche MQ (1970) Pulmonary extravascular water volume during halothane-oxygen anesthesia in dogs. Anesthesiology 32:530–536
Mathers J, Benumof JL, Wahrenbrock EA (1977) General anesthetics and regional hypoxic pulmonary vasoconstriction. Anesthesiology 46:111–114
Milic-Emili J, Henderson JAM, Dolovich MB, Trop D, Kaneko K (1966) Regional distribution of inspired gas in the lung. J Appl Physiol 21:749–759
Millar RA, Beard DJ, Hulands GH (1971) Oxyhaemoglobin dissociation curves in vitro with and without the anaesthetics halothane and cyclopropane. Br J Anaesth 43:1003–1011
Miller AH (1925) Ascending respiratory paralysis under general anesthesia. JAMA 84:201–202
Muller N, Volgyesi G, Becker L, Bryan MH, Bryan AC (1979) Diaphragmatic muscle tone. J Appl Physiol: Respir Environ Exercise Physiol 47:279–284
Munson ES, Larson CP Jr, Babad AA, Regan MJ, Buechel DR, Eger EI II (1966) The effects of halothane, fluroxene and cyclopropane on ventilation: a comparative study in man. Anesthesiology 27:716–728
Ngai SH, Katz RL, Farhie SE (1965) Respiratory effects of trichlorethylene, halothane and methoxyflurane in the cat. J Pharmacol Exp Ther 148:123–130
Nunn JF, Campbell EJM, Peckett BW (1959) Anatomical subdivisions of the volume of respiratory dead space and effect of posture of the jaw. J Appl Physiol 14:174–176
Nunn JF, Hill DW (1960) Respiratory dead space and arterial to end-tidal CO2 tension difference in anesthetized man. J Appl Physiol 15:383–389
Nunn JF (1964) Factors influencing the arterial oxygen tension during halothane anaesthesia with spontaneous respiration. Br J Anaesth 36:327–341
Price HL, Cooperman LH, Warden JC, Morris JJ, Smith TC (1969) Pulmonary hemodynamics during general anesthesia in man. Anesthesiology 30:629–636
Rehder K, Sittipong R, Sessler AD (1972) The effects of thiopental-meperidine anesthesia with succinylcholine paralysis on functional residual capacity and dynamic lung compliance in normal sitting man. Anesthesiology 37:395–398
Rehder K, Sessler AD (1973) Function of each lung in spontaneously breathing man anesthetized with thiopental-meperidine. Anesthesiology 38:320–327
Rehder K, Mallow JE, Fibuch EE, Krabill DR, Sessler AD (1974) Effects of isoflurane anesthesia and muscle paralysis on respiratory mechanics in normal man. Anesthesiology 41:477–485
Rehder K, Sessler AD, Marsh HM (1975) General anesthesia and the lung (state of the art). Am Rev Respirat Dis 112:541–563
Rehder K, Marsh HM, Rodarte Jr, Hyatt RE (1977) Airway closure (review article). Anesthesiology 47:40–52
Rehder K, Sessler AD, Rodarte Jr (1977) Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed man. J Appl Physiol: Respirat Environ Exercise Physiol 42:391–402
Rehder K, Knopp TJ, Sessler AD (1978) Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man. J Appl Physiol: Respirat Environ Exercise Physiol 45:528–535
Rehder K (1979) Anaesthesia and the respiratory system. Can Anaesth Soc J 26:451–462
Rehder K, Knopp TJ, Sessler AD, Didier EP (1979) Ventilation-perfusion relationship in young healthy awake and anesthetized-paralyzed man. J Appl Physiol: Respirat Environ Exercise Physiol 47:745–753
Rehder K, Marsh HM (1980) Gas exchange during anesthesia, Pulmonary Gas Exchange, vol. II, ed. JB West, Academic Press, Inc., New York, chapt. 4, pp. 149–185
Severinghaus JW, Stupfel M (1955) Respiratory dead space increase following atropine in man, and atropine, vagal or ganglionic blockade and hypothermia in dogs. J Appl Physiol 8:81–87
Severinghaus JW, Stupfel MA, Bradley AF (1957) Alveolar dead space and arterial to end-tidal carbon dioxide differences during hypothermia in dog and man. J Appl Physiol 10:349–355
Smith TC, Colton ET III, Behar MG (1970) Does anesthesia alter hemoglobin dissociation? Anesthesiology 32:5–10
Snow J (1858) On chloroform and other anaesthetics: Their action and administration. Churchill, London, p. 443
Stubbs SE, Hyatt RE (1972) Effect of increased lung recoil pressure on maximal expiratory flow in normal subjects. J Appl Physiol 32:325–331
Tusiewicz K, Bryan AC, Froese AB (1977) Contributions of changing rib cage-diaphragm interactions to the ventilatory depression of halothane anesthesia. Anesthesiology 47:327–337
Vellody VPS, Nassery M, Balasaraswathi K, Goldberg NB, Sharp JT (1978) Compliances of human rib cage and diaphragm-abdomen pathways in relaxed versus paralyzed states. Am Rev Respirat Dis 118:479–491
Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36:588–599
Weil JV, McCullough RE, Kline JS, Sodal IE (1975) Diminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. N Engl J Med 292:1103–1106
Westbrook PR, Stubbs SE, Sessler AD, Rehder K, Hyatt RE (1973) Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man. J Appl Physiol 34:81–86
Woo SW, Berlin D, Hedley-Whyte J (1969) Surfactant function and anesthetic agents. J Appl Physiol 26:571–577
Wulff KE, Aulin I (1972) The regional lung function in the lateral decubitus position during anesthesia and operation. Acta Anaesth Scand 16:195–205
Yacoub O, Doell D, Kryger MH, Anthonisen NR (1976) Depression of hypoxic ventilatory response by nitrous oxide. Anesthesiology 45:385–389
Young SL, Tierney DF, Clements JA (1970) Mechanism of compliance change in excised rat lungs at low transpulmonary pressure. J Appl Physiol 29:780–785
Author information
Authors and Affiliations
Additional information
This investigation was supported in part by Research Grants HL-21584 and GM-25196 from the National Institutes of Health. Doctor Gelb was a Parker B. Francis Foundation Fellow in Pulmonary Research.
Rights and permissions
About this article
Cite this article
Gelb, A.W., Southorn, P. & Rehder, K. Effect of general anaesthesia on respiratory function. Lung 159, 187–198 (1981). https://doi.org/10.1007/BF02713915
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02713915