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The Effect of Transverse Bolsters on Respiratory System Mechanics in Prone Anesthetized Infants


, : The Effect of Transverse Bolsters on Respiratory System Mechanics in Prone Anesthetized Infants. Anesthesiology Abstracts of Scientific Papers Annual Meeting (2000): Abstract No 1282

Introduction: We have previously demonstrated that respiratory system compliance is lower in the prone position compared with the supine position in the healthy anesthetized infant1. Transverse chest and pelvic bolsters are commonly employed in the prone position during anesthesia, in order to allow free abdominal excursion. This study was conducted to determine if the presence of bolsters alters respiratory system mechanics in the prone position. Methods: After institutional review board approval and with informed written parental consent, we studied 11 healthy (ASA 1) infants undergoing clubfoot correction in the prone position. Subjects had a mean age of 5.9 (+- 2.2) months and a mean weight of 7.8 (+- 0.9) kg. General anesthesia was standardized and included sevoflurane for induction, followed by rocuronium 1 mg.kg-1, nitrous oxide and isoflurane (1.5% expired) for maintenance. Analgesia was provided by caudal epidural blockade. Tidal volumes of 10 ml.kg-1 (I:E ratio 1:2) were delivered via a Datex pediatric circle system and a Datex AS/3 ventilator. Cuffed endotracheal tubes were used with the cuff inflated until the gas leak was just abolished. Patients were randomized as to whether measurements were taken either with or without bolsters inflated in the first instance. Respiratory system mechanics were measured with and without supportive bolsters using a Bicore CP-100 pulmonary function monitor (Irvine, CA) with a flow transducer and an occlusion valve at the endotracheal tube connector. Values are given as mean +- SD. VT and CDYN were corrected for weight. Data were compared with Student's paired t-test. A p-value of <0.05 was regarded as significant. Results: There were no statistically significant differences in any of the indices of respiratory mechanics with inflation/deflation of the bolsters (see table). Of note there were no differences in either static or dynamic compliance. Oxygen saturation, end-tidal PCO2, and hemodynamic variables (HR, BP) were also unchanged. Discussion: Adult studies2 have demonstrated that poor positioning technique may have a detrimental effect on respiratory system compliance. We have shown that the presence of transverse bolsters does not have any effect on respiratory system mechanics in infants. On the basis of respiratory system mechanics there is no advantage or disadvantage in using transverse bolsters in prone anesthetized infants, however there may be other advantages, such as improved venous return and more satisfactory head position, that may make the use of bolsters preferable.

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