The Prostate, Ventilation, and Anesthesia

In an aged patient with emphysema, respiratory complications might be expected to develop following perineal prostatectomy under spinal anesthesia in the exaggerated lithotomy (Young's) position. Complications have failed to occur at the expected rate, prompting a study of ventilation in the exaggerated lithotomy position. Nine control subjects demonstrated reductions in timed forced vital capacity (FVC) and forced expiratory volume (FEV 0.5 second) similar to those previously reported for healthy volunteers in the lithotomy position. Eighteen urological patients with pulmonary disease manifest by reduced FVC and FEV 0.5 second were studied before and during spinal anesthesia. They had no change in the FVC but an improved FEV 0.5 second in the exaggerated lithotomy position. The weight of the viscera and thighs probably acts to improve the end-exhalational position of the diaphragm and adds force to the maximum expiratory effort.