Lung aeration and ventilation after general anesthesia in left lateral position: a prospective observational study using electrical impedance tomography

Abstract

Background: Endoscopic submucosal dissection (ESD) under general anesthesia in left lateral position may lead to transient impairment of pulmonary function. We used electrical impedance tomography (EIT), an increasingly implied non-invasive instrument for bedside real-time monitoring regional changes in ventilation, to assess the changes of regional lung aeration and ventilation in patients undergoing ESD.

Methods: Twenty-two patients scheduled for elective ESD under mechanical ventilation in left lateral position were studied. We acquired 2-min EIT records at four time points: (M1) baseline, before induction of anesthesia, (M2) after the start of mechanical ventilation and before surgery, (M3) after surgery and before extubation, and (M4) after extubation and before leaving operation room, respectively. To quantify regional changes in lung ventilation, we calculated the ventilation proportion of left and right lung regions. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (EELI). Global inhomogeneity index (GI) was also analyzed.

Results: After tracheal intubation in the left lateral position, left lung showed a lower ventilation proportion (M1, 49.6% vs. M2, 36.2% P<0.05), a reduction in EELI {∆EELI -87 [-809; 253]} and a higher GI index value (M1, 0.29±0.09 vs. M2, 0.41±0.12, P<0.05), while right lung showed a higher ventilation proportion (M1, 50.4% vs. M2, 63.8%, P<0.05) and an increase in EELI {∆EELI 161 [-952; 1,905]}. During ESD operation, no changes in either regional ventilation distribution or GI index were observed. After extubation, the GI values in right and left lung were both returned to the level before anesthesia.

Conclusions: In patients with left lateral position undergoing ESD, left lung was characterized by decreased ventilation and more inhomogeneity while right lung was opposite after intubation. ESD procedure with carbon dioxide insufflation did not lead to significant changes in either regional ventilation or homogeneity. And the change of lung inhomogeneity during ESD procedure is transient.

Keywords: Lung ventilation; electrical impedance tomography (EIT); endoscopic submucosal dissection (ESD).