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Respiratory Mechanics During Anesthesia and Mechanical Ventilation

Kai Rehder, H. Michael Marsh

10.1002/cphy.cp030343

Source: Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing

Originally published: 1986

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 Effects of Anesthesia on the Chest Wall
1.1 Anesthesia With Spontaneous Breathing
1.2 Anesthesia‐Paralysis With Mechanical Ventilation of the Lungs
2 Effects of Anesthesia on FRC
3 Effects of Anesthesia on Pressure‐Volume Relationships
3.1 Total Respiratory System
3.2 Lungs
3.3 Chest Wall
3.4 Mechanisms for Changes in Pressure‐ Volume Relationships
4 Effects of Anesthesia on Pressure‐Flow Relationships
5 Effects of Anesthesia on Intrapulmonary Inspired‐Gas Distribution
5.1 Anesthesia With Spontaneous Breathing
5.2 Anesthesia‐Paralysis With Mechanical Ventilation of the Lungs
6 Conclusions
Figure 1.

Diagram of end‐expiratory position and pattern of motion of diaphragm in subject lying supine. Dashed line, end‐expiratory position of diaphragm in awake state; left margin of stippled area, end‐expiratory position of diaphragm in anesthetized state; stippled area, motion of diaphragm during active inspiration (spontaneous) or passive inflation (paralyzed). Note altered pattern of motion with passive inflation of lungs (paralyzed).

From Froese and Bryan 32
Figure 2.

Diagram of relative contribution to tidal volume from rib cage and abdomen in 3 states: awake, anesthetized, and anesthetized‐paralyzed. Equal contributions from rib cage and abdomen would result in a loop with a slope of 1. Note that relative contribution from rib cage to tidal volume is larger during anesthesia‐paralysis with mechanical ventilation and smaller during anesthesia with spontaneous breathing than in awake state.
Figure 3.

Contributions of rib cage (RC) and abdomen‐diaphragm (ABD) to inspiratory minute volume () at various partial pressures of CO2 () for 1 subject studied. Note lack of increase of rib cage contribution but normal increase of abdomen‐diaphragm contribution to with CO2 stimulation under anesthesia (0.8% halothane).

From Tusiewicz et al. 85
Figure 4.

Dynamic transpulmonary pressure [Δ(Pao - Pes)]‐lung volume change (ΔV) loops from dog lying prone, first awake and then anesthetized with halothane. Pao, airway opening pressure; Pes, esophageal pressure. During anesthesia loop is reversed (runs clockwise). To avoid possible artifacts, Pao was measured in the trachea 12,55.

From Rich et al. 72
Figure 5.

Possible mechanism for reversal of transpulmonary pressure‐lung volume (PV) loop. Only elastic pressure changes are considered. Pes, esophageal pressure; Pao, airway opening pressure; ΔV, lung volume change; FRC, functional residual capacity; VT, tidal volume. Assume Pes reflects radial stress on lung. During uniform expansion of lung (top) from FRC (A) to FRC + VT (B), radial stress increases from 2 to 6 cmH2O. Deflation from FRC + VT (B) to FRC (A) is also uniform. Thus the expiratory PV relationship is defined (dashed line, middle). During anesthesia the lung is assumed to be expanded uniaxially by contraction of diaphragm (A, bottom to B′, middle). Under these conditions when width does not change, radial stress increases less (in this example from 2 to 4 cmH2O) than during uniform expansion 74. This partly defines the inspiratory PV relationship (A to B′, middle). If at end inspiration the diaphragm relaxes and allows the lung to undergo an isovolume radial expansion (B′ to B, bottom), radial stress will increase (in this example from 4 to 6 cmH2O). This part of the inspiratory PV relationship is defined as B′ to B (middle). If uniform deflation then occurs (B to A, bottom), a reversed PV relationship results (middle).

From Rich et al. 72
Figure 6.

Top, diagram of changes in chest wall shape (thorax, A; abdomen, B) on going from awake (solid line) to anesthetized‐paralyzed (dashed line) state in humans lying supine. Note that at end expiration during anesthesia‐paralysis, anteroposterior diameters of both thorax and abdomen decrease, while lateral diameters increase. Bottom, with mechanical ventilation of lungs initiated from functional residual capacity (dashed line) going to functional residual capacity plus tidal volume (dotted line), anteroposterior diameters of both thorax and abdomen increase, while lateral diameters decrease.
Figure 7.

A: comparative measurements of functional residual capacity (FRC) (n = 128) between awake and anesthetized states for recumbent humans 24,25,41,42,49,66,68,70,90. Mean FRC awake is 2.68 ± 0.08 (SE) liters, whereas mean FRC anesthetized or anesthetized‐paralyzed is 2.17 ± 0.06 liters. B: frequency distribution of change in FRC (n = 128) associated with induction of anesthesia or anesthesia‐paralysis in recumbent humans.
Figure 8.

A: spirogram obtained from subject lying supine who was anesthetized with 400 mg of thiopental sodium (arrows). Tracing should be read from right to left. Note almost immediate reduction of functional residual capacity of about 200 ml after injection of thiopental sodium. B: spirogram obtained from anesthetized subject lying supine who was paralyzed with 100 mg of succinylcholine chloride (arrow). Again, tracing should be read from right to left. Note unchanged end‐expiratory level during ensuing period of apnea.

From Howell and Peckett 47
Figure 9.

Mean deflation pressure‐volume relationships for total respiratory system, lung, and chest wall, obtained from 5 subjects lying supine. Pao, airway opening pressure; Ptp, transpulmonary pressure; Pes, esophageal pressure.

From Westbrook et al. 90
Figure 10.

Mean transpulmonary pressure (PL) measured at 50% of total lung capacity (TLC) awake from 5 subjects lying supine, plotted as function of the ratio of functional residual capacity (FRC) in the awake (▪), anesthetized (•), or anesthetized‐paralyzed (▴) states to residual volume (RV) awake.
Figure 11.

Mean deflation pressure‐volume (PV) relationship for isolated dog lung before (○) and after (•) ventilation for 30 min with nitrous oxide (N2O, n = 7), chloroform (CHCl3, n = 8), or halothane (n = 11) in air. Note large rightward shift of PV curve with chloroform and halothane and minimal change with nitrous oxide.

From Woo et al. 92
Figure 12.

Mean ventilation index () plotted as function of vertical distance down the lung in awake (solid line) and anesthetized‐paralyzed (dashed line) subjects. , ratio of measured regional 133Xe concentration to that predicted if inspired‐gas distribution had been uniform. Inspiration was initiated from functional residual capacity and tidal volume equaled 10% of total lung capacity. There is virtually uniform inspired‐gas distribution in right lateral decubitus position during anesthesia‐paralysis. Inspired‐gas distribution becomes more uniform in supine position but less uniform in seated subjects after induction of anesthesia‐paralysis. Anesthesia‐paralysis has little effect on gas distribution in subjects lying prone.

From Rehder et al. 66
Figure 13.

Regional lung volumes plotted as function of overall lung volume for 1 dependent and 1 nondependent lung region oriented along same vertical axis. D, vertical distance down the lung; TLC, total lung capacity; TLCr, regional TLC. Data are from 1 subject studied first awake and then anesthetized‐paralyzed while lying in lateral decubitus position. Note large increase in vertical gradient of regional lung volumes in anesthetized‐paralyzed state and curvilinear relationship between regional and overall lung volume.

From Rehder et al. 70
Figure 14.

Mean multiple‐breath nitrogen clearances for individual lungs from awake 53 and anesthetized‐paralyzed subjects 64 lying in right lateral decubitus position. Note more uniform clearances of individual lungs during anesthesia‐paralysis; because these were 2 different groups of subjects, absolute values for functional residual capacity (FRC) should not be compared. Note also altered distributions of tidal volume between the 2 lungs, which are indicated by the arrow length in airways of diagrammatic inserts in each panel.

From Rehder et al. 64


Figure 1.

Diagram of end‐expiratory position and pattern of motion of diaphragm in subject lying supine. Dashed line, end‐expiratory position of diaphragm in awake state; left margin of stippled area, end‐expiratory position of diaphragm in anesthetized state; stippled area, motion of diaphragm during active inspiration (spontaneous) or passive inflation (paralyzed). Note altered pattern of motion with passive inflation of lungs (paralyzed).

From Froese and Bryan 32


Figure 2.

Diagram of relative contribution to tidal volume from rib cage and abdomen in 3 states: awake, anesthetized, and anesthetized‐paralyzed. Equal contributions from rib cage and abdomen would result in a loop with a slope of 1. Note that relative contribution from rib cage to tidal volume is larger during anesthesia‐paralysis with mechanical ventilation and smaller during anesthesia with spontaneous breathing than in awake state.



Figure 3.

Contributions of rib cage (RC) and abdomen‐diaphragm (ABD) to inspiratory minute volume () at various partial pressures of CO2 () for 1 subject studied. Note lack of increase of rib cage contribution but normal increase of abdomen‐diaphragm contribution to with CO2 stimulation under anesthesia (0.8% halothane).

From Tusiewicz et al. 85


Figure 4.

Dynamic transpulmonary pressure [Δ(Pao - Pes)]‐lung volume change (ΔV) loops from dog lying prone, first awake and then anesthetized with halothane. Pao, airway opening pressure; Pes, esophageal pressure. During anesthesia loop is reversed (runs clockwise). To avoid possible artifacts, Pao was measured in the trachea 12,55.

From Rich et al. 72


Figure 5.

Possible mechanism for reversal of transpulmonary pressure‐lung volume (PV) loop. Only elastic pressure changes are considered. Pes, esophageal pressure; Pao, airway opening pressure; ΔV, lung volume change; FRC, functional residual capacity; VT, tidal volume. Assume Pes reflects radial stress on lung. During uniform expansion of lung (top) from FRC (A) to FRC + VT (B), radial stress increases from 2 to 6 cmH2O. Deflation from FRC + VT (B) to FRC (A) is also uniform. Thus the expiratory PV relationship is defined (dashed line, middle). During anesthesia the lung is assumed to be expanded uniaxially by contraction of diaphragm (A, bottom to B′, middle). Under these conditions when width does not change, radial stress increases less (in this example from 2 to 4 cmH2O) than during uniform expansion 74. This partly defines the inspiratory PV relationship (A to B′, middle). If at end inspiration the diaphragm relaxes and allows the lung to undergo an isovolume radial expansion (B′ to B, bottom), radial stress will increase (in this example from 4 to 6 cmH2O). This part of the inspiratory PV relationship is defined as B′ to B (middle). If uniform deflation then occurs (B to A, bottom), a reversed PV relationship results (middle).

From Rich et al. 72


Figure 6.

Top, diagram of changes in chest wall shape (thorax, A; abdomen, B) on going from awake (solid line) to anesthetized‐paralyzed (dashed line) state in humans lying supine. Note that at end expiration during anesthesia‐paralysis, anteroposterior diameters of both thorax and abdomen decrease, while lateral diameters increase. Bottom, with mechanical ventilation of lungs initiated from functional residual capacity (dashed line) going to functional residual capacity plus tidal volume (dotted line), anteroposterior diameters of both thorax and abdomen increase, while lateral diameters decrease.



Figure 7.

A: comparative measurements of functional residual capacity (FRC) (n = 128) between awake and anesthetized states for recumbent humans 24,25,41,42,49,66,68,70,90. Mean FRC awake is 2.68 ± 0.08 (SE) liters, whereas mean FRC anesthetized or anesthetized‐paralyzed is 2.17 ± 0.06 liters. B: frequency distribution of change in FRC (n = 128) associated with induction of anesthesia or anesthesia‐paralysis in recumbent humans.



Figure 8.

A: spirogram obtained from subject lying supine who was anesthetized with 400 mg of thiopental sodium (arrows). Tracing should be read from right to left. Note almost immediate reduction of functional residual capacity of about 200 ml after injection of thiopental sodium. B: spirogram obtained from anesthetized subject lying supine who was paralyzed with 100 mg of succinylcholine chloride (arrow). Again, tracing should be read from right to left. Note unchanged end‐expiratory level during ensuing period of apnea.

From Howell and Peckett 47


Figure 9.

Mean deflation pressure‐volume relationships for total respiratory system, lung, and chest wall, obtained from 5 subjects lying supine. Pao, airway opening pressure; Ptp, transpulmonary pressure; Pes, esophageal pressure.

From Westbrook et al. 90


Figure 10.

Mean transpulmonary pressure (PL) measured at 50% of total lung capacity (TLC) awake from 5 subjects lying supine, plotted as function of the ratio of functional residual capacity (FRC) in the awake (▪), anesthetized (•), or anesthetized‐paralyzed (▴) states to residual volume (RV) awake.



Figure 11.

Mean deflation pressure‐volume (PV) relationship for isolated dog lung before (○) and after (•) ventilation for 30 min with nitrous oxide (N2O, n = 7), chloroform (CHCl3, n = 8), or halothane (n = 11) in air. Note large rightward shift of PV curve with chloroform and halothane and minimal change with nitrous oxide.

From Woo et al. 92


Figure 12.

Mean ventilation index () plotted as function of vertical distance down the lung in awake (solid line) and anesthetized‐paralyzed (dashed line) subjects. , ratio of measured regional 133Xe concentration to that predicted if inspired‐gas distribution had been uniform. Inspiration was initiated from functional residual capacity and tidal volume equaled 10% of total lung capacity. There is virtually uniform inspired‐gas distribution in right lateral decubitus position during anesthesia‐paralysis. Inspired‐gas distribution becomes more uniform in supine position but less uniform in seated subjects after induction of anesthesia‐paralysis. Anesthesia‐paralysis has little effect on gas distribution in subjects lying prone.

From Rehder et al. 66


Figure 13.

Regional lung volumes plotted as function of overall lung volume for 1 dependent and 1 nondependent lung region oriented along same vertical axis. D, vertical distance down the lung; TLC, total lung capacity; TLCr, regional TLC. Data are from 1 subject studied first awake and then anesthetized‐paralyzed while lying in lateral decubitus position. Note large increase in vertical gradient of regional lung volumes in anesthetized‐paralyzed state and curvilinear relationship between regional and overall lung volume.

From Rehder et al. 70


Figure 14.

Mean multiple‐breath nitrogen clearances for individual lungs from awake 53 and anesthetized‐paralyzed subjects 64 lying in right lateral decubitus position. Note more uniform clearances of individual lungs during anesthesia‐paralysis; because these were 2 different groups of subjects, absolute values for functional residual capacity (FRC) should not be compared. Note also altered distributions of tidal volume between the 2 lungs, which are indicated by the arrow length in airways of diagrammatic inserts in each panel.

From Rehder et al. 64
References
 1. Agostoni, E. Mechanics of the pleural space. Physiol. Rev. 52: 57-128, 1972.
 2. Agostoni, E., and P. Mognoni. Deformation of the chest wall during breathing efforts. J. Appl. Physiol. 21: 1827-1832, 1966.
 3. Aviado, D. M. Regulation of bronchomotor tone during anesthesia. Anesthesiology 42: 68-80, 1975.
 4. Bergman, N. A. Distribution of inspired gas during anesthesia and artificial ventilation. J. Appl. Physiol. 18: 1085-1089, 1963.
 5. Bergman, N. A., and C. L. Waltemath. A comparison of some methods for measuring total respiratory resistance. J. Appl. Physiol. 36: 131-134, 1974.
 6. Bishop, B. Reflex control of abdominal muscles during positive‐pressure breathing. J. Appl. Physiol. 19: 224-232, 1964.
 7. Briscoe, W. A., and A. B. DuBois. The relationship between airway resistance, airway conductance and lung volume in subjects of different age and body size. J. Clin. Invest. 37: 1279-1285, 1958.
 8. Brownlee, W. E., and F. F. Allbritten, Jr. The significance of the lung‐thorax compliance in ventilation during thoracic surgery. J. Thorac. Surg. 32: 454-463, 1956.
 9. Campbell, E. J. M., J. F. Nunn, and B. W. Peckett. A comparison of artificial ventilation and spontaneous respiration with particular reference to ventilation‐bloodflow relationships. Br. J. Anaesth. 30: 166-175, 1958.
 10. Caro, C. G., J. Butler, and A. B. DuBois. Some effects of restriction of chest cage expansion on pulmonary function in man: an experimental study. J. Clin. Invest. 39: 573-583, 1960.
 11. Carpenter, F. G. Alteration in mammalian nerve metabolism by soluble and gaseous anesthetics. Am. J. Physiol. 187: 573-578, 1956.
 12. Chang, H. K., and J. P. Mortola. Fluid dynamic factors in tracheal pressure measurement. J. Appl. Physiol.: Respirat. Environ. Exericse Physiol. 51: 218-225, 1981.
 13. Chevalier, P. A., J. F. Greenleaf, R. A. Robb, and E. H. Wood. Biplane videoroentgenographic analysis of dynamic regional lung strains in dogs. J. Appl. Physiol. 40: 118-122, 1976.
 14. Clarke, S. W., P. D. Graf, and J. A. Nadel. In vivo visualization of small‐airway constriction after pulmonary microembolism in cats and dogs. J. Appl. Physiol. 29: 646-650, 1970.
 15. Colgan, F. J., and T. B. Whang. Anesthesia and atelectasis. Anesthesiology 29: 917-922, 1968.
 16. Collier, C. R., and J. Mead. Pulmonary exchange as related to altered pulmonary mechanics in anesthetized dogs. J. Appl. Physiol. 19: 659-664, 1964.
 17. Crago, R. R., A. C. Bryan, A. K. Laws, and A. E. Winestock. Respiratory flow resistance after curare and pancuronium, measured by forced oscillations. Can. Anaesth. Soc. J. 19: 607-614, 1972.
 18. Decramer, M., S. Kelly, A. De Troyer, and P. Macklem. Regional differences in abdominal pressure swings in supine dogs (Abstract). Physiologist 26: A‐114, 1983.
 19. De Jong, R. H., W. N. Hershey, and I. H. Wagman. Measurement of a spinal reflex response (H‐reflex) during general anesthesia in man. Association between reflex depression and muscular relaxation. Anesthesiology 28: 382-389, 1967.
 20. Déry, R., J. Pelletier, A. Jacques, M. Clavet, and J. Houde. Alveolar collapse induced by denitrogenation. Can. Anaesth. Soc. J. 12: 531-544, 1965.
 21. Dobbinson, T. L., H. I. A. Nisbet, D. A. Pelton, and H. Levison. Functional residual capacity (FRC) and compliance in anaesthetised paralysed children. II. Clinical results. Can. Anaesth. Soc. J. 20: 322-333, 1973.
 22. Dohi, S., and M. I. Gold. Pulmonary mechanics during general anaesthesia. The influence of mechanical irritation on the airway. Br. J. Anaesth. 51: 205-213, 1979.
 23. Don, H. F., and J. G. Robson. The mechanics of the respiratory system during anesthesia. The effects of atropine and carbon dioxide. Anesthesiology 26: 168-178, 1965.
 24. Don, H. F., W. M. Wahba, and D. B. Craig. Airway closure, gas trapping, and the functional residual capacity during anesthesia. Anesthesiology 36: 533-539, 1972.
 25. Don, H. F., M. Wahba, L. Cuadrado, and K. Kelkar. The effects of anesthesia and 100 per cent oxygen on the functional residual capacity of the lungs. Anesthesiology 32: 521-529, 1970.
 26. Eger, E. I., II. Anesthetic Uptake and Action. Baltimore, MD: Williams & Wilkins, 1974.
 27. Foster, C. A., P. J. D. Heaf, and S. J. G. Semple. Compliance of the lung in anesthetized paralyzed subjects. J. Appl. Physiol. 11: 383-384, 1957.
 28. Fouke, J. M., R. L. Pimmel, and P. A. Bromberg. Direct dynamic measurements of tracheal diameter. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 767-771, 1981.
 29. Fowler, W. S., E. R. Cornish, Jr., and S. E. Kety. Lung function studies. VIII. Analysis of alveolar ventilation by pulmonary N2 clearance curves. J. Clin. Invest. 31: 40-50, 1952.
 30. Frank, N. R. Influence of acute pulmonary vascular congestion on recoiling force of excised cats' lung. J. Appl. Physiol. 14: 905-908, 1959.
 31. Freund, F., A. Roos, and R. B. Dodd. Expiratory activity of the abdominal muscles in man during general anesthesia. J. Appl. Physiol. 19: 693-697, 1964.
 32. Froese, A. B., and A. C. Bryan. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242-255, 1974.
 33. Gal, T. J. Pulmonary mechanics in normal subjects following endotracheal intubation. Anesthesiology 52: 27-35, 1980.
 34. Gold, M. I., Y. H. Han, and M. Helrich. Pulmonary mechanics during anesthesia. III. Influence of intermittent positive pressure and relation to blood gases. Anesth. Analg. Cleveland 45: 631-641, 1966.
 35. Gold, M. I., and M. Helrich. Pulmonary compliance during anesthesia. Anesthesiology 26: 281-288, 1965.
 36. Grassino, A. E., and N. R. Anthonisen. Chest wall distortion and regional lung volume distribution in erect humans. J. Appl. Physiol. 39: 1004-1007, 1975.
 37. Grimby, G., G. Hedenstierna, and B. Löfström. Chest wall mechanics during artificial ventilation. J. Appl. Physiol. 38: 576-580, 1975.
 38. Hedenstierna, G., P.‐O. Järnberg, L. Torsell, and I. Gottlieb. Esophageal elastance in anesthetized humans. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 54: 1374-1378, 1983.
 39. Hedenstierna, G., H. Johansson, and B. Linde. Central blood pooling as an explanation for lowered FRC during anaesthesia? Thigh volume measurements by plethysmography. Acta. Anaesth. Scand. 26: 633-637, 1982.
 40. Hedenstierna, G., and G. McCarthy. Mechanics of breathing, gas distribution and functional residual capacity at different frequencies of respiration during spontaneous and artificial ventilation. Br. J. Anaesth. 47: 706-712, 1975.
 41. Hewlett, A. M., G. H. Hulands, J. F. Nunn, and J. R. Heath. Functional residual capacity during anaesthesia. II. Spontaneous respiration. Br. J. Anaesth. 46: 486-494, 1974.
 42. Hewlett, A. M., G. H. Hulands, J. F. Nunn, and J. S. Milledge. Functional residual capacity during anaesthesia. III. Artificial ventilation. Br. J. Anaesth. 46: 495-503, 1974.
 43. Hickey, R. F., P. D. Graf, J. A. Nadel, and C. P. Larson, Jr. The effects of halothane and cyclopropane on total pulmonary resistance in the dog. Anesthesiology 31: 334-343, 1969.
 44. Hickey, R. F., W. D. Visick, H. B. Fairley, and H. E. Fourcade. Effects of halothane anesthesia on functional residual capacity and alveolar‐arterial oxygen tension difference. Anesthesiology 38: 20-24, 1973.
 45. Holtzman, M. J., B.‐E. Skoogh, H. Hahn, K. Sasaki, P. Graf, and J. A. Nadel. Effect of general anesthetics on bronchomotor responses (Abstract). Physiologist 24 (4): 28, 1981.
 46. Hoppin, F. G., Jr., and J. Hildebrandt. Mechanical properties of the lung. In: Lung Biology in Health and Disease. Bioengineering Aspects of the Lung, edited by J. B. West. New York: Dekker, 1977, vol. 3, chapt. 2, p. 83-162.
 47. Howell, J. B. L., and B. W. Peckett. Studies of the elastic properties of the thorax of supine anaesthetized paralysed human subjects. J. Physiol. London 136: 1-19, 1957.
 48. Jones, J. G., D. Faithfull, C. Jordan, and B. Minty. Rib cage movement during halothane anaesthesia in man. Br. J. Anaesth. 51: 399-407, 1979.
 49. Juno, P., H. M. Marsh, T. J. Knopp, and K. Rehder. Closing capacity in awake and anesthetized‐paralyzed man. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 238-244, 1978.
 50. Kaneko, K., J. Milic‐Emili, M. B. Dolovich, A. Dawson, and D. V. Bates. Regional distribution of ventilation and perfusion as a function of body position. J. Appl. Physiol. 21: 767-777, 1966.
 51. Kaul, S. U., J. R. Heath, and J. F. Nunn. Factors influencing the development of expiratory muscle activity during anaesthesia. Br. J. Anaesth. 45: 1013-1018, 1973.
 52. Klineberg, P. L., K. Rehder, and R. E. Hyatt. Pulmonary mechanics and gas exchange in seated normal men with chest restriction. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 26-32, 1981.
 53. Lillington, G. A., W. S. Fowler, R. D. Miller, and H. F. Helmholz, Jr. Nitrogen clearance rates of right and left lungs in different positions. J. Clin. Invest. 38: 2026-2034, 1959.
 54. Linderholm, H. Lung mechanics in sitting and horizontal postures studied by body plethysmographic methods. Am. J. Physiol. 204: 85-91, 1963.
 55. Loring, S. H., E. A. Elliott, and J. M. Drazen. Kinetic energy loss and convective acceleration in respiratory resistance measurements. Lung 156: 33-42, 1979.
 56. Mead, J. Mechanical properties of lungs. Physiol. Rev. 41: 281-330, 1961.
 57. Mead, J., and C. Collier. Relation of volume history of lungs to respiratory mechanics in anesthetized dogs. J. Appl. Physiol. 14: 669-678, 1959.
 58. Milic‐Emili, J., J. A. M. Henderson, M. B. Dolovich, D. Trop, and K. Kaneko. Regional distribution of inspired gas in the lung. J. Appl. Physiol. 21: 749-759, 1966.
 59. Muller, N., G. Volgyesi, L. Becker, M. H. Bryan, and A. C. Bryan. Diaphragmatic muscle tone. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 47: 279-284, 1979.
 60. Nadel, J. A., H. J. H. Colebatch, and C. R. Olsen. Location and mechanism of airway constriction after barium sulfate microembolism. J. Appl. Physiol. 19: 387-394, 1964.
 61. Ngai, S. H., E. C. Hanks, and S. E. Farhie. Effects of anesthetics on neuromuscular transmission and somatic reflexes. Anesthesiology 26: 162-167, 1965.
 62. Nims, R. G., E. H. Conner, and J. H. Comroe, Jr. The compliance of the human thorax in anesthetized patients. J. Clin. Invest. 34: 744-750, 1955.
 63. Otis, A. B., C. B. McKerrow, R. A. Bartlett, J. Mead, M. B. McIlroy, N. J. Selverstone, and E. P. Radford, Jr. Mechanical factors in distribution of pulmonary ventilation. J. Appl. Physiol. 8: 427-443, 1956.
 64. Rehder, K., D. J. Hatch, A. D. Sessler, and W. S. Fowler. The function of each lung of anesthetized and paralyzed man during mechanical ventilation. Anesthesiology 37: 16-26, 1972.
 65. Rehder, K., D. J. Hatch, A. D. Sessler, H. M. Marsh, and W. S. Fowler. Effects of general anesthesia, muscle paralysis, and mechanical ventilation on pulmonary nitrogen clearance. Anesthesiology 35: 591-601, 1971.
 66. Rehder, K., T. J. Knopp, and A. D. Sessler. Regional intrapulmonary gas distribution in awake and anesthetized‐paralyzed prone man. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 45: 528-535, 1978.
 67. Rehder, K., T. J. Knopp, A. D. Sessler, and E. P. Didier. Ventilation‐perfusion relationship in young healthy awake and anesthetized‐paralyzed man. J. Appl. Physiol.: Respirat. Environ. Exericse Physiol. 47: 745-753, 1979.
 68. Rehder, K., J. E. Mallow, E. E. Fibuch, D. R. Krabill, and A. D. Sessler. Effects of isoflurane anesthesia and muscle paralysis on respiratory mechanics in normal man. Anesthesiology 41: 477-485, 1974.
 69. Rehder, K., and A. D. Sessler. Function of each lung in spontaneously breathing man anesthetized with thiopental‐meperidine. Anesthesiology 38: 320-327, 1973.
 70. Rehder, K., A. D. Sessler, and J. R. Rodarte. Regional intrapulmonary gas distribution in awake and anesthetized‐paralyzed man. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 391-402, 1977.
 71. Rehder, K., R. Sittipong, and A. D. Sessler. The effects of thiopental‐meperidine anesthesia with succinylcholine paralysis on functional residual capacity and dynamic lung compliance in normal sitting man. Anesthesiology 37: 395-398, 1972.
 72. Rich, C. R., K. Rehder, T. J. Knopp, and R. E. Hyatt. Halothane and enflurane anesthesia and respiratory mechanics in prone dogs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 46: 646-653, 1979.
 73. Rigg, J. R. A., and P. Rondi. Changes in rib cage and diaphragm contribution to ventilation after morphine. Anesthesiology 55: 507-514, 1981.
 74. Rodarte, J. R. Importance of lung material properties in respiratory system mechanics. Physiologist 20 (5): 21-25, 1977.
 75. Rothstein, E., F. B. Landis, and B. G. Narodick. Bronchospirometry in the lateral decubitus position. J. Thorac. Surg. 19: 821-829, 1950.
 76. Roussos, C. S., Y. Fukuchi, P. T. Macklem, and L. A. Engel. Influence of diaphragmatic contraction on ventilation distribution in horizontal man. J. Appl. Physiol 40: 417-424, 1976.
 77. Roussos, C. S., R. R. Martin, and L. A. Engel. Diaphragmatic contraction and the gradient of alveolar expansion in the lateral posture. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 43: 32-38, 1977.
 78. Safar, P., and L. Bachman. Compliance of the lungs and thorax in dogs under the influence of muscle relaxants. Anesthesiology 17: 334-346, 1956.
 79. Scheidt, M., R. E. Hyatt, and K. Rehder. Effects of rib cage or abdominal restriction on lung mechanics. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 1115-1121, 1981.
 80. Schmid, E. R., K. Rehder, T. J. Knopp, and R. E. Hyatt. Chest wall motion and distribution of inspired gas in anesthetized supine dogs. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 279-286, 1980.
 81. Slutsky, A. S., J. M. Drazen, C. F. O'Cain, and R. H. Ingram, Jr. Alveolar pressure‐airflow characteristics in humans breathing air, He‐O2, and SF6‐O2. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 51: 1033-1037, 1981.
 82. Snow, J. On Chloroform and Other Anaesthetics: Their Action and Administration. London: Churchill, 1858.
 83. Southorn, P., K. Rehder, and R. E. Hyatt. Halothane anesthesia and respiratory mechanics in dogs lying supine. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 49: 300-305, 1980.
 84. Stubbs, S. E., and R. E. Hyatt. Effect of increased lung recoil pressure on maximal expiratory flow in normal subjects. J. Appl. Physiol. 32: 325-331, 1972.
 85. Tusiewicz, K., A. C. Bryan, and A. B. Froese. Contributions of changing rib cage‐diaphragm interactions to the ventilatory depression of halothane anesthesia. Anesthesiology 47: 327-337, 1977.
 86. Van Lith, P., F. N. Johnson, and J. T. Sharp. Respiratory elastances in relaxed and paralyzed states in normal and abnormal men. J. Appl. Physiol. 23: 475-486, 1967.
 87. Vellody, V. P. S., M. Nassery, K. Balasaraswathi, N. B. Goldberg, and J. T. Sharp. Compliances of human rib cage and diaphragm‐abdomen pathways in relaxed versus paralyzed states. Am. Rev. Respir. Dis. 118: 479-491, 1978.
 88. Vellody, V. P., M. Nassery, W. S. Druz, and J. T. Sharp. Effects of body position change on thoracoabdominal motion. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 45: 581-589, 1978.
 89. Waud, B. E., and D. R. Waud. Effects of volatile anesthetics on directly and indirectly stimulated skeletal muscle. Anesthesiology 50: 103-110, 1979.
 90. Westbrook, P. R., S. E. Stubbs, A. D. Sessler, K. Rehder, and R. E. Hyatt. Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man. J. Appl. Physiol. 34: 81-86, 1973.
 91. Woo, S. W., D. Berlin, U. Büch, and J. Hedley‐Whyte. Altered perfusion, ventilation, anesthesia and lung‐surface forces in dogs. Anesthesiology 33: 411-418, 1970.
 92. Woo, S. W., D. Berlin, and J. Hedley‐Whyte. Surfactant function and anesthetic agents. J. Appl. Physiol. 26: 571-577, 1969.
 93. Wu, N., W. F. Miller, and N. R. Luhn. Studies of breathing in anesthesia. Anesthesiology 17: 696-707, 1956.
 94. Wulff, K. E., and I. Aulin. The regional lung function in the lateral decubitus position during anesthesia and operation. Acta. Anaesthesiol. Scand. 16: 195-205, 1972.
 95. Young, S. L., D. F. Tierney, and J. A. Clements. Mechanism of compliance change in excised rat lungs at low transpulmonary pressure. J. Appl. Physiol. 29: 780-785, 1970.

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Article Title: Respiratory Mechanics During Anesthesia and Mechanical Ventilation
 

How to Cite

Kai Rehder, H. Michael Marsh. Respiratory Mechanics During Anesthesia and Mechanical Ventilation. Compr Physiol 2011, Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing: 737-752. First published in print 1986. doi: 10.1002/cphy.cp030343