Atelectasis during anesthesia: physiology and treatment

LETTERS TO THE EDITOR

Atelectasis during anesthesia: physiology and treatment

(Rev Bras Anestesiol, 2008; 58(1):73-83)

To the Editor,

I read the study ¹ published on Revista Brasileira de Anestesiologia with great interest. I would like to compliment the authors for their commendable initiative. The following comments are done with the intent of clarifying a few aspects:

1) The authors stated that the reduction in pulmonary complacency and the worsening of gas exchange would be the parameters used as indication that alveolar recruiting maneuvers should be instituted. There was no mention for the biomedical device, diagnostic strategy, or monitor that should be used during surgery to make this diagnosis. Are there any? Which should be used?

2) The authors stated that recruiting maneuvers should be used as often as possible; however, they did not mention the ideal moment to institute those maneuvers. The III Consenso Brasileiro de Ventilação Mecânica (III Brazilian Consensus on Mechanical Ventilation) indicates that those maneuvers should be executed immediately after anesthetic induction in an attempt to minimize the moment of surgery that most atelectasis develop, i.e., during anesthetic induction ².

3) The authors also stated that the benefits of recruiting maneuvers go beyond reversal of atelectasis, which seemed to indicate that the benefits extend throughout the postoperative period; however, randomized clinical studies with a narrow confidence interval and adequate follow up to confirm the effects of those maneuvers in the postoperative period are needed, since the III Consenso de Ventilação Mecânica deemed it a B recommendation ².

I would like to applaud the efforts of the authors for their attempt to bring to Brazilian anesthesiologists a knowledge that benefits the patient during anesthesia.

Fabiano Timbó Barbosa, TSA

REFERENCES

• 01. Malbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC - Atelectasias durante anestesia: fisiopatologia e tratamento. Rev Bras Anestesiol, 2007; 58: 73-83.
• 02. Auler Junior JOC, Galas FRBG, Hajjar LA, Franca AS - III Consenso Brasileiro de Ventilação Mecânica: ventilação mecânica no intra-operatório. RBTI, 2007; 19: 393-398.

Publication Dates

• Publication in this collection
  14 Nov 2008
• Date of issue
  Dec 2008