Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients

Abstract

These alterations in pulmonary mechanics are less than those observed with comparable degrees of abdominal inflation in non-obese patients, and were well tolerated. From the point of view of intraoperative respiratory mechanics, laparoscopic surgery is safe in morbidly obese patients.

The effects of pneumoperitoneum pressure on blood gases, respiratory and venous systems during laparoscopic cholecystectomy: A prospective randomized trial

“…As IAP increases, dynamic compliance reduces whereas airway pressure, PP, and plateau pressures increase. [17][18][19][20][21][22] In our study, significant decreases in DC and increases in PIP during PP in both high and low PP groups were detected. In reference to the high PP group, decrease in DC and increase in PIP were less significant in low PP group.…”

Desafios no manuseio peri-operatório de pacientes obesos mórbidos: como prevenir complicações

“…A pressão inspirató-ria transpulmonar adequada e/ou PEEP para manter volume final expiratório, associado a elevadas frações de oxigênio (F I O 2 ) foram recomendados para preservar a oxigenação sangüínea 2,42 (Figura 1). Estudos relatam diferentes maneiras de lidar com esse problema, como altos níveis de F I O 2 e volume corrente (VC), PEEP e, até mesmo, ventilação em posição prona 43,44 . Em relação ao VC a ser estabelecido durante a anestesia para pacientes obesos mórbidos, a literatura enfoca três procedimentos principais: 1) volume corrente guiado pelos valores normais de CO 2 expirado 43 ; 2) alto volume corrente (15 a (peso ideal) 36 , de acordo com dados de mecânica respiratória.…”

“…Adequate transpulmonary inspiratory pressure and/or PEEP to maintain end expiratory volume, associated to high oxygen fractions (FiO 2 ) have been recommended to preserve blood oxygenation 2,42 ( Figure 1). Studies have reported different methods to deal with this problem, such as high FiO 2 and tidal volume (TV) levels, PEEP and even prone position ventilation 43,44 . As to TV to be determined during anesthesia for morbidly obese patients, the literature reports three major procedures: 1) tidal volume guided by normal expired CO 2 values 43 ; 2) high tidal volume (15 to 20 ml.kg ) adjusted according to optimal calculated weight 10 ; 3) some authors recommend high TV levels without mentioning exact values 2,45 .…”

“…Studies have reported different methods to deal with this problem, such as high FiO 2 and tidal volume (TV) levels, PEEP and even prone position ventilation 43,44 . As to TV to be determined during anesthesia for morbidly obese patients, the literature reports three major procedures: 1) tidal volume guided by normal expired CO 2 values 43 ; 2) high tidal volume (15 to 20 ml.kg ) adjusted according to optimal calculated weight 10 ; 3) some authors recommend high TV levels without mentioning exact values 2,45 . As compared to studies recommending TV levels above 15 ml.kg -1 of optimal weight, TV values used in our study were close to 0.62 l (calculated by optimal weight, TV was approximately 11 ml.kg .…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…Respiratory function is markedly impaired in morbidly obese patients (BMI C 40 kg/m 2 ) undergoing laparoscopic surgery. Several factors contribute to this effect on pulmonary function: supine position, muscle paralysis, and PP (LE 2b) [400,401]. The related reduced functional residual capacity, increased closing volume, and consequent atelectasis (LE 3a) [402,403] increase the risk for postoperative respiratory complications (LE 1b) [404] and prolonged length of hospital stay (LE 1b) [405].…”