[Combination anesthesia and bronchial tranport velocity. Effects of anesthesia with isoflurane, fentanyl, vecuronium and oxygen-nitrous oxide breathing on bronchial mucus transport]

Abstract

The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In general, it is assumed that anaesthetics inhibit mucociliary clearance [3,5,6,19,27]. In the present prospective study the effect of combination anaesthesia with isoflurane, fentanyl, vecuronium, and nitrous oxide-oxygen mixture on bronchial mucus transport velocity (BTV) was investigated.

Patients and methods: 10 patients undergoing major abdominal surgery were included in the study. The study was approved by the ethics committee of our hospital. In all patients anaesthesia was induced with propofol (1-2 mg/kg), fentanyl (0.2-0.3 mg/kg) and vecuronium (0.1 mg/kg). After intubation anaesthesia was maintained with 1.5 MAC isoflurane and repeated doses of fentanyl (0.1-0.2 mg) and vecuronium. Ventilation was assisted with a 2:1 mixture of nitrous oxide and oxygen. The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and postoperatively while they received intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope [15].

Results: Table 1 provides information about age, application of anaesthetics and duration of mechanical ventilation of the patients. The preoperative and postoperative BTV values showed no significant differences (Fig. 1).

Conclusions: Combination anaesthesia with isoflurane, fentanyl, vecuronium, and O2:N2O does not influence BTV in patients with healthy lungs.