Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: A randomised trial

Kim, W. H.; Hahm, Tae Soo; Kim, J. A.; Sim, Woo Seog; Choi, Duck Hwan; Lee, E. K.; Lee, S. M.

doi:10.1111/aas.12104

Cited by 48 publications

(54 citation statements)

References 36 publications

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“…However, previous studies report that prolonged inspiratory time did not deteriorate but rather improved CO 2 removal by decreasing airway dead space and increasing alveolar ventilation [4,23,24]. In addition, pressure-controlled ventilations with I/E ratios of 1:1 and 1:2 showed comparable CO 2 removal during laparoscopic bariatric surgery [6].…”

Section: Discussionmentioning

confidence: 90%

“…Prolonged I/E ratio ventilation, for example 1:1 or 2:1, was used to improve arterial oxygenation in patients with lung injury [3]. Studies on prolonged I/E ratio ventilation during laparoscopic surgery and one lung ventilation also reported favorable results in terms of oxygenation and respiratory mechanics [4,5]. Recently, prolonged I/E ratio ventilation of 1:1 was reported to improve arterial oxygenation in morbidly obese patients undergoing bariatric surgery [6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

Kim

Park

et al. 2015

OBES SURG

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

Kim

Park

et al. 2015

OBES SURG

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“…Pressurecontrolled ventilation was found to result in greater dynamic compliance and lower peak inspiratory airway pressure, compared with volume-controlled ventilation [30]. A prolonged inspiratory duration can be an alternative to producing better gaseous exchange conditions and respiratory mechanics [31]. I : E ratios of 2 : 1 or 1 : 1 provided better oxygenation and lower PaCO 2 levels than the conventional 1 : 2 ratio by preserved Vd/Vt in the steep Trendelenburg position.…”

Section: Prostatectomymentioning

confidence: 99%

Anesthetic Considerations with Robotic Surgery

Giordano

Gravenstein

2017

Atlas of Robotic Urologic Surgery

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Review ArticleRecently, demand for minimally invasive surgery has increased greatly. As a result, robot-assisted techniques have gained in popularity, because they overcome several of the shortcomings of conventional laparoscopic techniques. However, robotic surgery may require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel, which may go against the conservative nature of anesthesia care. Anesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to offer better anesthetic care and promote patient safety. (Korean J Anesthesiol 2014; 66: 3-11)

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“…A study demonstrated that the ventilation in VCV mode with an inspiratory/expiratory ratio (I:E) of 1:1 or 2:1 rises mean Paw and maintains oxygenation during pneumoperitoneum (65). A 5-cmH2O PEEP with I:E=1:2 produces the same outcomes, but increases peak and plateau pressures.…”

confidence: 99%

Artificial ventilation during pneumoperitoneum

Comuzzi¹

2014

SOB

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the complications pertaining to pneumoperitoneum to solve them quickly, paying particular attention to the patients at higher risk, such as elderly, obese, and those with cardiopulmonary disease. KEY WORDS: pneumoperitoneum, artificial ventilation, obesity, laparoscopy, anesthesia. IntroductionLaparoscopic surgery has been increasingly employed in various surgical subspecialties because of its innumerous benefits. These are evident during the post-operative period and result from the less important organ/tissue trauma caused by laparoscopic approaches than those triggered by open surgery. The main advantages of laparoscopic surgery are: reduction of the inflammatory and metabolic responses (1-3), reduced post-operative pain and analgesic consumption (2, 3), smaller incidence of respiratory complications (2), faster resolution of post-operative ileum and recovery (1). Taken together, these outcomes reduce hospital stay, promote a quicker return to normal daily activities (2-4), and reduce the cost of the treatment (4). On the other hand, laparoscopic surgery presents some challenges regarding the intra-operative anesthesia management, since there are respiratory and hemodynamic changes pertaining to the general anesthesia itself, to the abdominal insufflation, and to the intra-operative positioning of the patient (5). These issues become even more evident in patients with cardiopulmonary disease or obesity (6). This review focuses on the intra-operative respiratory alterations caused by laparoscopy and on the ventilatory strategies that are prone to minimize the modifications evoked by the technique. Alterations of the respiratory systemIn order to allow an adequate observation of the surgical field, laparoscopic surgery requires controlled gas insufflation into the peritoneal cavity (pneumoperitoneum). For this purpose, carbon dioxide is regularly used under a pressure of 10-15 mmHg. Naturally, respiratory issues related to mechanics and CO2 overload SummaryLaparoscopic surgery has been increasingly used in many surgical subspecialties, due to its various post-operative benefits. On the other hand, it presents intra-operative challenges to the anesthesia management. The inflation of the abdominal cavity with carbon dioxide leads to hemodynamic changes, mechanical respiratory system derangements (increased elastance, resistance and airway pressure), augmented V'CO2, and alterations of the V'/Q' ratio and of the PaCO2-PetCO2 gradient. All these changes may be influenced by other factors, such as body position and baseline characteristics of the patient. To minimize the negative consequences of these modifications a protective ventilation strategy with the use of low tidal volumes and PEEP, eventually associated with recruitment maneuvers, is suggested. No ventilatory mode or anesthetic drug has been proven better than the others. It has been suggested that the use of supraglotic devices may be a safe alternative to endotracheal intubation during laparoscopic surgery. It is important that the anesthetist be aware ...

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Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: A randomised trial

Cited by 48 publications

References 36 publications

The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

Anesthetic Considerations with Robotic Surgery

Artificial ventilation during pneumoperitoneum

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