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Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery

Published online by Cambridge University Press:  01 March 2007

V. Chalhoub ,
A. Yazigi ,
G. Sleilaty ,
F. Haddad ,
R. Noun ,
S. Madi-Jebara  and
P. Yazbeck
V. Chalhoub
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
A. Yazigi
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
G. Sleilaty
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
F. Haddad
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
R. Noun
Affiliation:
Hotel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon
S. Madi-Jebara
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
P. Yazbeck
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
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Summary

Background

Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of a vital capacity manoeuvre (VCM), followed by ventilation with positive end-expiratory pressure (PEEP), on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Methods

Fifty-two morbidly obese patients (body mass index >40 kg m−2) undergoing open bariatric surgery were enrolled in this prospective and randomized study. Anaesthesia and surgical techniques were standardized. Patients were ventilated with a tidal volume of 10 mL kg−1 of ideal body weight, a mixture of oxygen and nitrous oxide (FiO2 = 40%) and respiratory rate was adjusted to maintain end-tidal carbon dioxide at a level of 30–35 mmHg. After abdominal opening, patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O. This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups. Haemodynamics, ventilatory and arterial oxygenation parameters were measured at the following times: T0 = before application of VCM and/or PEEP, T1 = 5 min after VCM and/or PEEP and T2 = before abdominal closure.

Results

Patients in the two groups were comparable regarding patient characteristics, surgical, haemodynamic and ventilatory parameters. In Group 1, arterial oxygen partial pressure (PaO2) and arterial haemoglobin oxygen saturation (SaO2) were significantly increased and alveolar-arterial oxygen pressure gradient (A-aDO2) decreased at T2 when compared with T0 and T1. In Group 2, PaO2 and SaO2 were significantly increased and A-aDO2 decreased at T1 and T2 when compared with T0. Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1.

Conclusion

The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Keywords

SURGERY, abdominal, bariatricRESPIRATORY FUNCTION TESTS, gas exchangeMECHANICAL VENTILATIONMORBID OBESITYPOSITIVE PRESSURE RESPIRATION
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 283 - 288
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Robert, WV, Leslie, W. Intraoperative arterial oxygenation in obese patients. Ann Surg 1976; 184 (1): 35–41.Google Scholar
2.Oberg, B, Poulsen, TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand 1996; 40 (2): 191–200.Google Scholar
3.Wyner, J, Brodsky, JB, Merrell, RC. Massive obesity and arterial oxygenation. Anesth Analg 1981; 60 (9): 691–693.CrossRefGoogle ScholarPubMed
4.Hedenstierna, G, Santesson, J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand 1976; 20: 248–254.Google Scholar
5.Biring, MS, Lewis, MI, Liu, JT, Mohsenifar, Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci 1999; 318 (5): 293–297.Google Scholar
6.Tokics, L, Hedenstierna, G, Strandberg, A, Brismar, B, Lundquist, H. Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis and positive end-expiratory pressure. Anesthesiology 1987; 66 (2): 157–167.CrossRefGoogle ScholarPubMed
7.Damia, G, Mascheroni, D, Croci, M, Tarenzi, L. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth 1988; 60 (5): 574–578.CrossRefGoogle ScholarPubMed
8.Pelosi, P, Croci, M, Ravagnan, I et al. . Respiratory system mechanics in sedated, paralyzed and morbidly obese patients. J Appl Physiol 1997; 82 (3): 811–818.Google Scholar
9.Pelosi, P, Croci, M, Ravagnan, I, Vicardi, P, Gattinoni, L. Total respiratory system, lung and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 1996; 109 (1): 144–151.CrossRefGoogle ScholarPubMed
10.Pelosi, P, Croci, M, Ravagnan, I et al. . The effects of body mass on lung volumes, respiratory mechanics and gas exchange during general anesthesia. Anesth Analg 1998; 87 (3): 4–60.CrossRefGoogle ScholarPubMed
11.Eichenberger, A, Proietti, S, Wicky, S et al. . Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 95 (6): 1788–1792.CrossRefGoogle ScholarPubMed
12.Hedenstierna, G, Santesson, J, Norlander, O. Airway closure and distribution of inspired gas in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand 1976; 20 (4): 334–342.CrossRefGoogle ScholarPubMed
13.Holley, HS, Milic-Emili, J, Becklake, MR, Bates, DV. Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest 1967; 46 (4): 475–481.Google Scholar
14.Dempsey, JA, Reddan, W, Balke, B, Rankin, J. Work capacity determinants and physiologic cost of weight-supported work in obesity. J Appl Physiol 1966; 21 (6): 1815–1820.Google Scholar
15.Visick, WD, Fairley, HB, Hickey, RF. The effects of tidal volume and end-expiratory pressure on pulmonary gas exchange during anesthesia. Anesthesiology 1973; 39 (3): 285–290.CrossRefGoogle ScholarPubMed
16.Sprung, J, Whalley, DG, Falcone, T, Wilks, W, Navratil, JE, Bourke, DL. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth Analg 2003; 97 (1): 268–274.CrossRefGoogle ScholarPubMed
17.Bardoczky, GI, Yernault, JC, Houben, JJ, d’Hollander, AA. Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg 1995; 81 (2): 385–388.Google Scholar
18.Pregaldien, A, Hans, G, De Roever, A, Lamy, M, Joris, J. Pressure-controlled ventilation does not improve gas exchange in morbidly obese patients undergoing gastric by-pass. Anesthesiology 2005; 103 : A1402 (Abstract).Google Scholar
19.Pelosi, P, Ravagnan, I, Giurati, G et al. . Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999; 91 (5): 1221–1231.CrossRefGoogle Scholar
20.Perilli, V, Sollazzi, L, Modesti, C et al. . Comparison of positive end-expiratory pressure with reverse Trendelenburg position in morbidly obese patients undergoing bariatric surgery: effects on hemodynamics and pulmonary gas exchange. Obes Surg 2003; 13 (4): 605–609.CrossRefGoogle ScholarPubMed
21.Salem, MR, Dalal, FY, Zygmunt, MP, Mathrubhutham, M, Jacobs, HK. Does PEEP improve intraoperative arterial oxygenation in grossly obese patients? Anesthesiology 1978; 48 (4): 280–281.CrossRefGoogle ScholarPubMed
22.Lachmann, B. Open up the lung and keep the lung open. Intensive Care Med 1992; 18 (6): 319–321.Google Scholar
23.Rothen, HU, Sporre, B, Engberg, G, Wegenius, G, Hedenstierna, G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 1993; 71 (6): 788–795.Google Scholar
24.Rothen, HU, Sporre, B, Engberg, G, Wegenius, G, Hedenstierna, G. Reexpansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand 1995; 39 (1): 118–125.CrossRefGoogle ScholarPubMed
25.Murphy, GS, Szokol, JW, Curran, RD, Votapka, TV, Vender, JS. Influence of a vital capacity manoeuvre on pulmonary gas exchange after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2001; 15 (3): 336–340.Google Scholar
26.Tusman, G, Bohm, SH, Vazquez de Anda, GF, do Campo, JL, Lachmann, B. ‘Alveolar recruitment strategy’ improves arterial oxygenation during general anaesthesia. Br J Anaesth 1999; 82 (1): 8–13.CrossRefGoogle ScholarPubMed
27.Dyhr, T, Nygard, E, Laursen, N, Larsson, A. Both lung recruitment manoeuvre and PEEP are needed to increase oxygenation and lung volume after cardiac surgery. Acta Anaesthesiol Scand 2004; 48 (2): 187–197.Google Scholar
28.Whalen, FX, Gajic, O, Thompson, GB et al. . The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006; 102 (1): 298–305.Google Scholar
29.D’Angelo, E, Calderini, E, Tavola, M, Bono, D, Milic-Emili, J. Effect of PEEP on respiratory mechanics in anesthetized paralyzed humans. J Appl Physiol 1992; 73 (5): 1736–1742.Google Scholar
30.Horton, WG, Cheney, FW. Variability of effect of positive end expiratory pressure. Arch Surg 1975; 110 (4): 395–398.CrossRefGoogle ScholarPubMed
31.Eriksen, J, Andersen, J, Rasmussen, JP, Sorensen, B. Effects of ventilation with large tidal volumes or positive end-expiratory pressure on cardiorespiratory function in anesthetized obese patients. Acta Anaesthesiol Scand 1978; 22 (3): 241–248.Google Scholar
32.Bein, T, Kuhr, LP, Bele, S, Ploner, F, Keyl, C, Taeger, K. Lung recruitment maneuver in patients with cerebral injury: effects on intracranial pressure and cerebral metabolism. Intensive Care Med 2002; 28: 554–558.CrossRefGoogle ScholarPubMed
33.Sprung, J, Whalley, DG, Falcone, T, Warner, DO, Hubmayr, RD, Hammel, J. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 2002; 94 (5): 1345–1350.Google Scholar
34.JrAuler, JO, Miyoshi, E, Fernandes, CR, Bensenor, FE, Elias, L, Bonassa, J. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg 2002; 94 (3): 741–748.Google Scholar
35.Perilli, V, Sollazzi, L, Bozza, P et al. . The effects of the reverse Trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg 2000; 91 (6): 1520–1525.Google Scholar
36.Magnusson, L, Wicky, S, Tyden, H, Hedenstierna, G. Repeated vital capacity manoeuvres after cardiopulmonary bypass: effects on lung function in a pig model. Br J Anaesth 1998; 80 (5): 682–684.Google Scholar
37.Yazigi, A, Dagher, C, Richa, F, Madi-jebara, S. Effect of vital capacity maneuvers on postoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. Anesthesiology 2004; 101 : A1553 (Abstract).Google Scholar