EFFECTS OF AIRWAY ANESTHESIA ON PATTERN OF BREATHING AND BLOOD-GASES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE DURING ACUTE RESPIRATORY-FAILURE

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Abstract
To assess the role played by airway receptors in the genesis of rapid and shallow breathing of patients with chronic obstructive pulmonary disease (COPD), effects of airway anesthesia were studied in 14 patients with COPD during acute respiratory failure. Airway anesthesia was performed by fiberoptic xylocaine administration from the larynx to the subsegmental bronchi, all patients being intubated or tracheostomized. A small decrease in minute ventilation of 6 .+-. 1% of the control values occurred after airway anesthesia. This was due to a decrease (P < 0.01) in respiratory frequency (f) (14.5 .+-. 1%). The latter resulted from an increase (P < 0.0005) in expiratory time; inspiratory time did not change significantly. Tidal volume increased (P < 0.02) by 10.1 .+-. 0.6%. In all patients, these modifications were accompanied by arterial blood gas deterioration, mean PaO2 [arterial partial pressure] and PaCO2 of 42 .+-. 3 mm Hg and 62 .+-. 3 mm Hg, respectively, 15 min after xylocaine administration, as compared to 48 .+-. 2 mm Hg and 54 .+-. 2 mm Hg, respectively, during the control period. No correlation was found between the changes in minute ventilation and PaO2 or PaCO2. Activation of airway receptors is involved in the determination of the rapid and shallow breathing observed in patients with COPD during acute respiratory failure. Airway xylocaine anesthesia that worsens arterial blood gases is contraindicated in these patients.

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