Effects of 3 MAC of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelium in vitro.

We have measured the effects of three times the minimum alveolar concentration (MAC) of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelial brushings from 18 healthy adult patients. Using the transmitted light technique and paired perfusion chambers, the cilia were exposed to 2.25% halothane, 5% enflurane or 3.6% isoflurane in air, or air alone, in a controlled and blinded manner. Over a 4-h observation period, cilia beat frequency of the samples exposed to inhalation anaesthetic agents demonstrated a significant reduction in frequency compared with controls exposed to air alone. Mean cilia beat frequency for the samples exposed to halothane was 9.3 (SEM 1.3) compared with its controls of 11.4 (1.0); for the samples exposed to enflurane, 10.9 (1.3) compared with its controls of 11.6 (1.2); and for the samples exposed to isoflurane, 10.8 (1.1) compared with its controls of 11.6 (1.2). There was a statistically significant difference between the samples exposed to all three volatile agents and their associated controls (halothane, P = 0.01; enflurane, P = 0.03; isoflurane, P = 0.01; nested repeated measures analysis of variance utilizing polynomial contrasts).

An optical technique for the measurement of thoracic wall movement during high-frequency jet ventilation.

Instrumentation for use in high-frequency jet ventilation is not currently capable of providing information suitable for predicting gas exchange. Whilst techniques for the accurate measurement of tidal volume during jet ventilation are now available, the relationship between tidal volume and the efficiency of gas exchange varies with frequency and inspiratory/expiratory time (I:E) ratio. We report technical details of a new non-invasive instrument capable of accurately measuring displacement of the thoracic wall at high frequencies and without electrical connection to the patient. It is hoped that use of this instrument will allow the calculation of an efficiency index for the transduction of airway pressure changes into peripheral expansion. It is also hoped that this index may be of value in predicting the gas exchange response to changes in jet parameters.

Measurement of entrainment ratio during high frequency jet ventilation.

We have measured tidal (VT), entrained (Ve) and "blowback" (Vbb) volumes during high frequency jet ventilation (HFJV) through a Mallinckrodt Hi-Lo Jet tracheal tube in anaesthetized patients. The above volumes were calculated by digital integration of the appropriate regions of flow curves derived from a pneumotachograph placed between the bias flow tubing and the tracheal tube. At a driving pressure of 1 bar, lung minute ventilation increased with increasing ventilatory frequency, whilst tidal volumes decreased. The contribution of entrainment to tidal volume (Ve/VT) remained constant, although the volumes entrained were relatively small and varied widely from subject to subject. Blowback volumes were considerable, especially at ventilatory frequencies used clinically (1-2 Hz). We conclude that it is not possible to entrain predictable concentrations of volatile agents from the low pressure bias flow during HFJV.

Relationship between resonance and gas exchange during high frequency jet ventilation.

We have studied the relationship between gas exchange and mechanical frequency response during high frequency jet ventilation (HFJV) at 0.5-5.0 Hz in anaesthetized pigs. The mechanical gain curve showed a minimal "anti-resonant" response at 0.8 Hz (f1) and a maximal "resonant" response at 5.0 Hz (f2). This finding may be explained by modelling the thorax and abdomen as a system of coupled masses and compliances which undergo two different modes of forced oscillation in the frequency range studied. Gas exchange was optimal in the frequency range between the minimal and maximal responses. The tidal volumes produced were greater than anatomical deadspace, suggesting that gas transport was mainly convective in this range.