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Canadian Journal of Anesthesia, Vol 25, 166-172, Copyright © 1978 by Canadian Anesthesiologists' Society

Intermittent Mandatory Ventilation and Controlled Mechanical Ventilation Without Positive End-Expiratory Pressure Following Cardio-Pulmonary Bypass

ROBERT N. SLADEN M.B., M.R.C.P.1 and LEONARD C. JENKINS M.D., C.M., F.R.C.P.(C)1

1 Department of Anaesthesiology, University of British Columbia, Vancouver General Hospital, Vancouver, B.C., Canada, V5Z IM9

In a group of 18 male patients undergoing coronary artery bypass grafting with cardio-pulmonary bypass, the overall incidence of post-operative atelectasis was 60 per cent. Nearly three-quarters occurred during anaesthesia. After operation there was no difference whether CMV or IMV without PEEP was provided overnight. Atelectasis already present did not improve and further atelectasis occurred.

A role for IMV is not excluded, since it facilitates the use of PEEP. Many factors operate and interact to provoke atelectasis during anaesthesia, which increases post-operative morbidity. Many of these factors are preventible or reversible if their physiological basis is understood.

Optimal post-operative ventilation should be tailored to the needs of the individual patient and demands close co-operation between anaesthetist and surgeon.




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