The effect of total intravenous anesthesia with propofol, alfentanil and vecuronium (TIVA) on bronchial mucosal transport

Abstract

The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In the present prospective study the effect of total intravenous anaesthesia with propofol, alfentanil, vecuronium, and oxygen-air ventilation on bronchial mucus transport velocity (BTV) was investigated. 10 patients undergoing major abdominal surgery were included in the study. In all patients anaesthesia was induced and maintained with propofol, alfentanil, and vecuronium. Ventilation was assisted with a mixture of air and oxygen (FiO2:0.35). The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and after the end of the operation during intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labelled with technetium -99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronches via a catheter placed in the inner channel of a fibre-optic bronchoscope [7]. The study was approved by the ethics committee of our hospital. The administered dose of propofol was 3.0 g (1.8-5.5), of alfentanil 26 mg (20-50), and of vecuronium 20 mg (16-34) (median with range). The duration of mechanical ventilation up to the time of measurement was 5 h (3.0-9.5). TIVA produced a decrease of BTV in the right (9.7 vs 4.9 mm/min) and left main bronchus (11.3 mm/min vs 5.3 mm/min). Total intravenous anaesthesia with propofol, alfentanil, and vecuronium depressed mucociliary flow in patients with healthy lungs. The period for recovery of mucociliary clearance and the possible disadvantage in patients with increased pulmonary risk (e.g. patients with chronic bronchitis and abdominal surgery) should be clarified in further studies.