Anesthesia and the Control of Ventilation

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Anesthesia and the Control of Ventilation

Edward G. Pavlin, Thomas F. Hornbein

10.1002/cphy.cp030225

Source: Supplement 11: Handbook of Physiology, The Respiratory System, Control of Breathing

Originally published: 1986

Published online: January 2011

Full Article on Wiley Online Library

Abstract
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References

Abstract

The sections in this article are:

1 Assessment of Drug Effects on Breathing

1.1 CO2 Response

1.2 Hypoxic Response

2 Ventilatory Response to CO2

2.1 Inhalation Agents

2.2 Narcotics

2.3 Sedatives

2.4 Ventilatory Stimulants

2.5 Muscle Relaxants

3 Ventilatory Response to Hypoxia

4 Ventilatory Response to Loading

5 Ventilatory Drive and Timing

6 Conclusion

	Figure 1. Comparison of mean arterial partial pressure of CO₂ (Paco₂) in patients anesthetized with 1 of 7 anesthetics. Patients were resting, spontaneously ventilating, and unstimulated. MAC, minimum alveolar concentration. From Hickey and Severinghaus 58
	Figure 2. Comparison of mean changes in tidal volume at multiples of minimum alveolar concentrations (MAC) in patients anesthetized with 1 of 6 anesthetics. From Hickey and Severinghaus 58
	Figure 3. Comparison of mean changes in respiratory frequency at multiples of minimum alveolar concentrations (MAC) obtained in patients anesthetized with 1 of 6 anesthetics. From Hickey and Severinghaus 58
	Figure 4. Comparison of mean slopes of ventilatory response to inhaled CO₂ at multiples of minimum alveolar concentrations (MAC) in patients anesthetized with 1 of 6 anesthetics. Values on ordinate are expressed as fraction of awake slope. From Hickey and Severinghaus 58
	Figure 5. Ventilatory responses to increased CO₂ and apneic thresholds during ether, Forane (isoflurane), or halothane anesthesia in patients. Note that apneic threshold in this study appeared to have relative fixed relationship to resting arterial partial pressure of CO₂ (Paco₂). Ve, expired minute ventilation. From Hickey et al. 57
	Figure 6. Ventilatory response to CO₂ after morphine (2 mg/kg body wt) and antagonism by naloxone infusion (40 μg/kg body wt). From Johnstone et al. 70
	Figure 7. Effect of halothane anesthesia at different doses on 3 different tests of ventilatory drive in human subjects. Ventilatory drive to hypoxia seems to be depressed at much lower levels of halothane anesthesia than does ventilatory increase to inhaled CO₂. From Knill and Gelb 74
	Figure 8. Comparison of arterial CO₂ tension (Paco₂) during halothane anesthesia and spontaneous ventilation relative to preoperative forced expiratory volume in 1 s (FEV₁). Patients with chronic obstructive pulmonary disease (○) did not exhibit CO₂ retention prior to anesthesia; however, degree of alveolar hypoventilation is much greater in more severely obstructed patients. •, Normal patients. From Pietak et al. 107
	Figure 9. Comparison of subjects anesthetized with methoxyflurane (○) with group of normal conscious individuals (•). At each level of alveolar CO₂ tension (Paco₂), values [e.g., of minute ventilation ()] from each subject were averaged to give single point. A, ventilatory response; B, change in inspiratory (Ti) and total (Ttot) cycle durations with CO₂; C, tidal volume response; D, mean inspiratory flow (Vt/Ti) response; E, occlusion pressure (P_0.1) response; F, Vt/Ti vs. P_0.1. Width of dashed lines indicate one standard error of the mean. From Derenne et al. 30
	Figure 10. Comparison of volume‐time relationships in patients undergoing surgery while anesthetized with halothane or enflurane. Vt, tidal volume; MAC, minimum alveolar concentration; f, frequency; PAco₂, alveolar CO₂ tension. Data from Byrick and Janssen 16

Figure 1.

Comparison of mean arterial partial pressure of CO₂ (Paco₂) in patients anesthetized with 1 of 7 anesthetics. Patients were resting, spontaneously ventilating, and unstimulated. MAC, minimum alveolar concentration.

From Hickey and Severinghaus 58

Figure 2.

Comparison of mean changes in tidal volume at multiples of minimum alveolar concentrations (MAC) in patients anesthetized with 1 of 6 anesthetics.

From Hickey and Severinghaus 58

Figure 3.

Comparison of mean changes in respiratory frequency at multiples of minimum alveolar concentrations (MAC) obtained in patients anesthetized with 1 of 6 anesthetics.

From Hickey and Severinghaus 58

Figure 4.

Comparison of mean slopes of ventilatory response to inhaled CO₂ at multiples of minimum alveolar concentrations (MAC) in patients anesthetized with 1 of 6 anesthetics. Values on ordinate are expressed as fraction of awake slope.

From Hickey and Severinghaus 58

Figure 5.

Ventilatory responses to increased CO₂ and apneic thresholds during ether, Forane (isoflurane), or halothane anesthesia in patients. Note that apneic threshold in this study appeared to have relative fixed relationship to resting arterial partial pressure of CO₂ (Paco₂). Ve, expired minute ventilation.

From Hickey et al. 57

Figure 6.

Ventilatory response to CO₂ after morphine (2 mg/kg body wt) and antagonism by naloxone infusion (40 μg/kg body wt).

From Johnstone et al. 70

Figure 7.

Effect of halothane anesthesia at different doses on 3 different tests of ventilatory drive in human subjects. Ventilatory drive to hypoxia seems to be depressed at much lower levels of halothane anesthesia than does ventilatory increase to inhaled CO₂.

From Knill and Gelb 74

Figure 8.

Comparison of arterial CO₂ tension (Paco₂) during halothane anesthesia and spontaneous ventilation relative to preoperative forced expiratory volume in 1 s (FEV₁). Patients with chronic obstructive pulmonary disease (○) did not exhibit CO₂ retention prior to anesthesia; however, degree of alveolar hypoventilation is much greater in more severely obstructed patients. •, Normal patients.

From Pietak et al. 107

Figure 9.

Comparison of subjects anesthetized with methoxyflurane (○) with group of normal conscious individuals (•). At each level of alveolar CO₂ tension (Paco₂), values [e.g., of minute ventilation ()] from each subject were averaged to give single point. A, ventilatory response; B, change in inspiratory (Ti) and total (Ttot) cycle durations with CO₂; C, tidal volume response; D, mean inspiratory flow (Vt/Ti) response; E, occlusion pressure (P_0.1) response; F, Vt/Ti vs. P_0.1. Width of dashed lines indicate one standard error of the mean.

From Derenne et al. 30

Figure 10.

Comparison of volume‐time relationships in patients undergoing surgery while anesthetized with halothane or enflurane. Vt, tidal volume; MAC, minimum alveolar concentration; f, frequency; PAco₂, alveolar CO₂ tension.

Data from Byrick and Janssen 16

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Edward G. Pavlin, Thomas F. Hornbein. Anesthesia and the Control of Ventilation. Compr Physiol 2011, Supplement 11: Handbook of Physiology, The Respiratory System, Control of Breathing: 793-813. First published in print 1986. doi: 10.1002/cphy.cp030225

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