Alveolar Recruitment and Arterial Desflurane Concentration During Bariatric Surgery

Šprung, Juraj; Whalen, Francis X.; Comfere, Thomas B.; Bošnjak, Željko J.; Bajzer, Željko; Gajic, Ognjen; Sarr, Michael G.; Schroeder, Darrell R.; Liedl, Lavonne M.; Offord, Chetan P.; Warner, David O.

doi:10.1213/ane.0b013e31818db6c7

Cited by 35 publications

(47 citation statements)

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“…Only one of these 2 studies was included, for a total of 6 studies receiving a Jadad score of Ն 3. 14,19,20,[27][28][29] The 2013 study by Futier et al 30 was not included because of the excessively large V T in the control group (10 -12 mL/kg), as well as the lack of a protocol to account for confounding variables with their primary outcome measurements.…”

Section: Results Of Searchmentioning

confidence: 99%

“…14,19,27 Subjects in 5 studies had an average body mass index of Ͼ 25 kg/m 2 . 19,20,[27][28][29] Two studies included subjects with a 28 Elective non-laparoscopic abdominal surgery under general anesthesia expected to last Ͼ 2 h, Ͼ 18 y old BMI Ͼ 40 kg/m 2 ; laparoscopic or emergency surgery; previous lung surgery; persistent hemodynamic instability; intractable shock considered unsuitable for the study by the subject's managing physician; COPD history; repeated systemic corticosteroid therapy for exacerbations of COPD, asthma, or sleep disorders; recent immunosuppressive medication defined as need for chemotherapy or radiation therapy; Ͻ 2 months after chemotherapy or radiation therapy; severe cardiac disease defined as New York Heart Association class III or IV or acute coronary syndrome; persistent ventricular tachyarrhythmias; pregnancy (by lab testing); acute lung injury or ARDS, expected to require prolonged postoperative mechanical ventilation; any neuromuscular disease; contraindications to position an epidural catheter because of major clotting disorders or sign of infection at the site of the procedure Sprung et al 29 BMI In 5 studies, the average age of subjects was Ͼ 40 y. Two studies included subjects with a mean age of Ͼ 65 y.…”

Section: Subjectsmentioning

confidence: 99%

“…Two studies included subjects with a mean age of Ͼ 65 y. 14,20,28,29 The ratio between men and women varied with each study, but overall, there was a slightly higher number of male subjects. Specific exclusion criteria are shown in Table 2.…”

Section: Subjectsmentioning

confidence: 99%

“…There was an increase in intraoperative P aO 2 in the alveolar recruitment maneuver groups compared with control groups in the 4 studies in which this outcome was measured. 14,19,20,27 Sprung et al 29 included P aO 2 /F IO 2 in their results, whereas Severgnini et al 28 included only intraoperative S pO 2 .…”

Section: Primary Outcomesmentioning

confidence: 99%

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Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature

2014

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BACKGROUND:The sigh is a normal homeostatic reflex that maintains lung compliance and decreases atelectasis. General anesthesia abolishes the sigh reflex with rapid onset of atelectasis in 100% of patients. Studies show a strong correlation between atelectasis and postoperative pulmonary complications, raising health-care costs. Alveolar recruitment maneuvers recruit collapsed alveoli, increase gas exchange, and improve arterial oxygenation. There is no consensus in the literature about the benefits of alveolar recruitment maneuvers. A systematic review is necessary to delineate their usefulness. METHODS: The search strategy included utilizing PubMed, CINAHL, the Cochrane Library, the National Guideline Clearinghouse, and all subsequent research reference lists up to January 2014. Inclusion criteria involved studies that compared the use of an alveolar RESPIRATORY CARE • APRIL 2015 VOL 60 NO 4 609 recruitment maneuver with a control group lacking an alveolar recruitment maneuver in adult surgical subjects not suffering from ARDS or undergoing cardiac or thoracic surgeries. RESULTS: Six randomized controlled trials of the 439 studies initially identified achieved a score of > 3 on the Jadad scale and were included in this review. Alveolar recruitment maneuvers consisted of a stepwise increase in tidal volume to a plateau pressure of 30 cm H 2 O, a stepwise increase in PEEP to 20 cm H 2 O, or sustained manual inflations of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cm H 2 O. Subjects in the alveolar recruitment maneuver groups experienced a higher intraoperative P aO 2 with improved lung compliance. Different alveolar recruitment maneuvers were equally effective. There was a significant advantage when alveolar recruitment maneuvers were followed by PEEP application. CONCLUSIONS: Alveolar recruitment maneuvers followed by PEEP should be instituted after induction of general anesthesia, routinely during maintenance, and in the presence of a falling S pO 2 whenever feasible. They allow the anesthesia provider to reduce the F IO 2 while maintaining a higher S pO 2 , limiting the masking of shunts. Utilization of alveolar recruitment maneuvers may reduce postoperative pulmonary complications and improve patient outcomes.

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Section: Results Of Searchmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 99%

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Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature

2014

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“…This model is motivated by the idea that by generalizing the gamma variate function to include the stretched exponential, one can only better approximate the multiexponential function related to multicompartment models. On the other hand the stretched exponential contains the power function (t/) c , which is a signature of fractal kinetics (1,2,26). It is likely that fractal kinetics plays a role in physiological processes involved, as they are happening in spaces exhibiting fractal structures.…”

Section: Methodsmentioning

confidence: 99%

A gamma variate model that includes stretched exponential is a better fit for gastric emptying data from mice

Bajzer

Gibbons

Coleman

et al. 2015

American Journal of Physiology-Gastrointestinal and Liver Physi

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Bajzer Ž, Gibbons SJ, Coleman HD, Linden DR, Farrugia G. A gamma variate model that includes stretched exponential is a better fit for gastric emptying data from mice. Am J Physiol Gastrointest Liver Physiol 309: G162-G170, 2015. First published June 4, 2015; doi:10.1152/ajpgi.00280.2014.-Noninvasive breath tests for gastric emptying are important techniques for understanding the changes in gastric motility that occur in disease or in response to drugs. Mice are often used as an animal model; however, the gamma variate model currently used for data analysis does not always fit the data appropriately. The aim of this study was to determine appropriate mathematical models to better fit mouse gastric emptying data including when two peaks are present in the gastric emptying curve. We fitted 175 gastric emptying data sets with two standard models (gamma variate and power exponential), with a gamma variate model that includes stretched exponential and with a proposed two-component model. The appropriateness of the fit was assessed by the Akaike Information Criterion. We found that extension of the gamma variate model to include a stretched exponential improves the fit, which allows for a better estimation of T 1/2 and Tlag. When two distinct peaks in gastric emptying are present, a two-component model is required for the most appropriate fit. We conclude that use of a stretched exponential gamma variate model and when appropriate a two-component model will result in a better estimate of physiologically relevant parameters when analyzing mouse gastric emptying data. motility; smooth muscle; gastrointestinal tract; empirical mathematical models THE MEASUREMENT OF GASTRIC emptying in human subjects and animal models of disease is an important technique for understanding the changes in gastric motility that occur under normal physiological conditions, in disease, or in response to drugs. Acute physiological changes in gastric emptying can be identified in response to the content and nature of a meal including the effects of calories, osmolarity, lipid, protein, and carbohydrate content (9). Determination of gastric emptying has clinical relevance since the delay of gastric emptying of solids is required for positive diagnosis of gastroparesis. Gastroparesis can occur secondary to drugs or systemic disease as a complication of diabetes or remain idiopathic (21). Accelerated gastric emptying is also observed in subsets of patients with symptoms suggestive of functional dyspepsia, or dumping, as well as in a subset of patients with diabetes particularly early after diagnosis (12,25). Accelerated gastric emptying is also observed in animal models of diabetes (7). Prokinetic agents have been identified and studied by using gastric emptying tests in experimental animals and candidate drugs have been tested for unwanted effects on gastric emptying (24).Several noninvasive tests have been developed to follow gastric emptying in humans including scintigraphy and breath tests (5, 29), and some of these tests have been applied for ...

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Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Sun

Zhang

et al. 2020

Pediatric Pulmonology

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Aim To explore the effect of incremental positive end‐expiratory pressure recruitment maneuver (iPEEPRM) in children with congenital heart diseases (CHDs) using lung ultrasound. Methods Thirty‐six children aged 3 months to 5 years scheduled for cardiac surgery participated. iPEEPRM was performed with PEEP stepwise increase (0‐5‐10‐15 cmH2O) and decrease at the same rate before and after surgery. Atelectatic areas, ultrasound scores, arterial oxygen pressure (PaO2), and respiratory system dynamic compliance per kilogram body weight (CDyn/kg) were analyzed before and after iPEEPRM. The primary outcome is the incidence of atelectasis. Secondary outcomes are oxygenation, ventilation, CDyn/kg, and atelectasis area. Results iPEEPRM was successfully applied in 92% (33/36) children before surgery and 71% (24/34) children after surgery. The incidence of atelectasis was significantly reduced by iPEEPRM from 76% to 15% before surgery and from 92% to 38% after surgery, respectively (P < .001). Before surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 32.5 (0‐128.1) mm2 vs 0 (0‐0) mm2 and 8 (3‐12) vs 2 (0‐4). PaO2 and CDyn/kg were significantly increased after iPEEPRM: 243 (129‐275) mm Hg vs 278 (207‐323) mm Hg and 0.6 (0.4‐0.7) mL/cmH2O/kg vs 0.8 (0.6‐1.0) mL/cmH2O/kg. After surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 45.7 (13.1‐115.8) mm2 vs 0 (0‐34.7) mm2, and 9 (6‐12) vs 3 (0‐5). PaO2 and CDyn/kg were also significantly increased after iPEEPRM. Conclusions iPEEPRM effectively reduced atelectasis, improved lung aeration, oxygenation, and CDyn/kg in children undergoing cardiac surgery.

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Alveolar Recruitment and Arterial Desflurane Concentration During Bariatric Surgery

Abstract: Although the RM during bariatric surgery represents an effective method for improving intraoperative oxygenation, it does not significantly affect the desflurane blood concentrations during anesthesia or its elimination during emergence.

Cited by 35 publications

References 21 publications

Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature

Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature

A gamma variate model that includes stretched exponential is a better fit for gastric emptying data from mice

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

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