PHRENIC-NERVE STIMULATION DURING HALOTHANE ANESTHESIA

Background: Atelectasis formation during anesthesia may be due to loss of respiratory muscle tone, in particular that of the diaphragm. This was tested by tensing the diaphragm by phrenic nerve stimulation (PNS) and observing the effect on atelectasis. Methods: Twelve patients (mean age 48 yr) without preexisting lung disease were studied during halothane anesthesia. PNS was executed with an external electrode on the right side of the neck. Chest dimensions and area of atelectasis were studied by computed tomography of the chest. Results: Right-sided PNS against an occluded airway at functional residual capacity reduced the atelectatic area in the tight lung from 5.1 to 3.8 cm(2). The atelectasis was reduced to 1.1 cm(2) after application of positive end-expiratory pressure (PEEP) of 10 cmH(2)O and large tidal volumes but increased to 2.5 cm(2) within 1 min after discontinuation of PEEP. Commencement of PNS immediately after PEEP prevented the atelectasis from increasing, the mean area being 0.9 cm(2). In seven patients, in whom the trachea was intubated with a double-lumen endobronchial catheter the atelectatic area was smaller during PNS with an open airway than during positive pressure inflation of the lung with the same volume as inspired during PNS (3.5 and 5.2 cm(2), respectively. Conclusions: The findings indicate that contracting the diaphragm in the anesthetized subject reduces the size of atelectasis.