Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants: A prospective randomised controlled trial.
The reported incidence of atelectasis during induction of general anaesthesia in children is between 68-100%. In this study the authors wished to investigate whether maintaining spontaneous ventilation would reduce atelectasis formation during anaesthesia induction in infants.
The study was carried out at a single centre in Seoul, South Korea between November 2018 and December 2019. 60 children were enrolled, all had an IV induction with 6mg/kg thiopental, anaesthesia was then maintained with sevoflurane while preoxygenation took place. Participants were randomised 1:1 into either a spontaneous ventilation group or a control (standard BMV) group. 4 were excluded from the spontaneous group because of loss of spontaneous ventilation during induction. Lung ultrasound was used to identify atelectasis following a 5-minute preoxygenation period.
Atelectasis was seen in 7 (26.9%) of the 26 patients in the spontaneous group vs. 22 (73.3%) of 30 in the control group. The difference was most significant in dependant areas of the lung.
Limitations of this study
- Preoperative ultrasound to exclude pre-existing atelectasis was not done.
- Atelectasis was not further investigated postoperatively – the authors state that this was because all patients with evidence of atelectasis had a recruitment manoeuvre preformed and that airway management following ultrasound was not controlled for and could therefore not be excluded as the cause of postoperative atelectasis.
- Infants in the control group were given a dose of rocuronium to facilitate BMV. This may have increased atelectasis due to the paralysis of the diaphragm.
Take home message
Maintaining spontaneous ventilation during induction of general anaesthesia reduces atelectasis in children aged under 1 year, particularly in dependant areas of the lung. In this study the clinical implications of this atelectasis were not further investigated and the control and intervention groups were not followed postoperatively.
Reviewed by Kate O’Hare