Effect of BMI and Patient Positioning on Airway Pressures and Respiratory Compliance during Laparoscopic Surgery

Kim, Yong Bum; Chang, Chul Ho; Kim, So Yeon; Nam, Yoonho

doi:10.4097/kjae.2006.50.3.302

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…This is in accordance with our study and that of Kim [9] and Sprung [10] where patient BMI and insufflation of pneumoperitoneum had the most important influence on respiratory mechanics. In the present study, the decrease was 61 % compared with a 30 % decrease in the study performed by Kim [9]. This may be explained by the differences in patients’ physical status (ASA classification) between the two studies.…”

Section: Discussionsupporting

confidence: 94%

Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery

Tomescu

Popescu

Dima

et al. 2016

J Clin Monit Comput

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Robotic assisted surgery (RAS) represents a great challenge for anesthesiology due to the increased intraabdomial pressures required for surgical optimal approach. The changes in lung physiology are difficult to predict and require fast decision making in order to prevent altered gas exchange. The aim of this study was to document the combined effect of patient physical status, medical history and intraoperative position during RAS on lung physiology and to determine perioperative risk factors for hypercapnia. We prospectively analyzed 62 patients who underwent elective RAS. Age, co-morbidities and body mass index (BMI) were recorded before surgery. Ventilatory parameters and arterial blood gas analysis were determined before induction of anesthesia, after tracheal intubation and on an hourly basis until the end of surgery. In RAS, the induction of pneumoperitoneum was associated with a significant decrease in lung compliance from a mean of 42.5–26.7 ml cm H2O−1 (p = 0.001) and an increase in plateau pressure from a mean of 16.1 mmHg to a mean of 23.6 mmHg (p = 0.001). Obesity, demonstrated by a BMI over 30, significantly correlates with a decrease in lung compliance after induction of anesthesia (p = 0.001). A significant higher increase in arterial CO2 tension was registered in patients undergoing RAS in steep Trendelenburg position (p = 0.05), but no significant changes in end-tidal CO2 were recorded. A higher arterial to end-tidal CO2 tension gradient was observed in patients with a BMI > 30 (p < 0.001). In conclusion, patients’ physical status, especially obesity, represents the main risk factor for decreased lung compliance during RAS and patient positioning in either Trendelenburg or steep Trendelenburg during surgery has limited effects on respiratory physiology.

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Section: Discussionsupporting

confidence: 94%

Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery

Tomescu

Popescu

Dima

et al. 2016

J Clin Monit Comput

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“…This leads to an increase in PIP and Raw as well as a decrease in functional residual capacity and pulmonary compliance [5,16,20-23]. Oikkonen and Tallgren [16] reported that there was no association between age, sex, BMI, duration of pressurization, or changes in Cdyn during laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…During laparoscopy, peritoneal CO 2 insufflation increases intra-abdominal pressure, elevates the diaphragm, and increases intra-thoracic pressure [ 20 ]. This leads to an increase in PIP and Raw as well as a decrease in functional residual capacity and pulmonary compliance [ 5 , 16 , 20 - 23 ]. Oikkonen and Tallgren [ 16 ] reported that there was no association between age, sex, BMI, duration of pressurization, or changes in Cdyn during laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, other studies have reported that several factors (patient's position, BMI, anesthetic agents etc.) affect the extent of respiratory mechanics changes during laparoscopic surgery [ 5 , 16 , 20 , 22 , 23 ]. These changes could be aggravated in patients with pre-existing pulmonary diseases, or morbid obesity [ 21 , 22 ], which is why we excluded these patients.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy

Bang

Lee

Ahn

et al. 2014

Korean J Anesthesiol

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BackgroundThe creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy.MethodsSixty patients undergoing laparoscopic colectomy were randomly allocated to one of the two groups: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5).ResultsIn both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05).ConclusionsRespiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.

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“…It has been reported that the BMI and creation of pneumoperitonum affected lung compliance, but that 10° and 30° reverse Trendelenburg or Trendelenburg position did not show further statistically significant changes [ 14 , 15 ]. Moreover, it has been reported that pneumoperitoneum led to decrease of lung compliance and increase of PIP and also the degree of pneumoperitoneum gave influence to the degree of those changes, but that 20° reverse Trendelenburg or Trendelenburg position did not show further statistically significant changes [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery

Suh

Seong

Jung

et al. 2010

Korean J Anesthesiol

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BackgroundConventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure.MethodsTwenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated.ResultsFollowing creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes.ConclusionsThe effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

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Effect of BMI and Patient Positioning on Airway Pressures and Respiratory Compliance during Laparoscopic Surgery

Cited by 5 publications

References 18 publications

Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery

Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery

Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy

The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery

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