Płynna wyściółka dróg oddechowych i transport śluzowo-rzęskowy. Czy znieczulenie ogólne może wpływać na ich funkcję?

Piotr Smuszkiewicz¹, Tomasz Tyrakowski², Leon Drobnik¹

Summary
Mucus clearance is an important component of the lung´s innate defence against disease, and the ability of the airways to clear mucus is strongly dependent on the volume of liquid on airway surfaces. Airway epithelium regulates ion concentration, volume and electric potential of the airways´ surface liquid. Mucus hydration is determined by the volume of liquid present on airway surfaces, which in turn may be modified by active ion transport. The latter can be markedly compromised by various anaesthesia activities, such as decreased temperature and humidity of inspired gases and mechanical ventilation. Halothane, enflurane and isoflurane impair ciliary beat frequency and mucus transport by depressing chloride epithelial ion transport. Propofol increases calcium ion concentration, therefore preserving ciliary transport and mucus clearance and should be recommended for longer sedation in intensive care settings. Mechanical ventilation with large tidal volumes and high oxygen concentration leads to decreased fluid clearance in the lung, increases permeability for small particles and impairs Na-K-ATPase activity. In conclusion, general anaesthesia and mechanical ventilation impair the airway surface liquid function, and can contribute to the development of respiratory complications in the perioperative period.

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