Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis

Aldenkortt, Marc; Lysakowski, Christopher; Elia, Nadia; Brochard, Laurent; Tramèr, Martin R.

doi:10.1093/bja/aes338

Cited by 155 publications

(92 citation statements)

References 48 publications

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“…The group with PEEP and RM showed improved intraoperative oxygenation. Futier et al [21] and Aldenkortt et al [22] also concluded that adding RMs and PEEP in obese patients improved oxygenation. This finding is inconsistent with that of Whalen et al [23], who investigated the effects of different PEEP levels (4 and 8 cm H 2 O) and RMs at a fixed VT of 8 ml/kg on intraoperative arterial oxygenation.…”

Section: Discussionmentioning

confidence: 97%

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

Eldemrdash¹,

Gamaleldeen²,

Ahmed³

et al. 2017

J Anesth Clin Res

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Background: Obesity is a serious problem worldwide. During general anesthesia and post-operative period, obese patients more likely to develop post-operative pulmonary complications as atelectasis and impaired pulmonary function compared to non-obese. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics.

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Section: Discussionmentioning

confidence: 97%

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

Eldemrdash¹,

Gamaleldeen²,

Ahmed³

et al. 2017

J Anesth Clin Res

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“…In addition greater opioid consumption in obese patients with obstructive sleep apnea can also result in postoperative hypoxemic events [27][28][29] . It remains to be determined if the opioid reduction due to the TAP infiltration can minimize opioid related side effects in morbid obese patients undergoing gastric reduction surgery.…”

Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

Oliveira

Fitzgerald

Ahmad

et al. 2014

WJGS

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AIM:To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS:The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS:Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03). CONCLUSION:The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.© 2014 Baishideng Publishing Group co., Limited. All rights reserved.Key words: Transversus abdominis plane; Infiltration; Gastric band; Pain; Recovery Core tip: In this current randomized, double blinded, placebo controlled pilot study we estimated the effect of a transversus abdominis plane block on postoperative quality of recovery in morbidly obese patients undergoing laparoscopic gastric band surgery. Postoperative opioid consumption was inversely correlated to quality of recovery in this surgical population. The transversus abdominis plane block seems to be an effective strategy to improve quality of recovery in those patients.

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“…[5,6] Obesity causes small airway collapse as well aschronic inflammation, and Interleukin-6 and Cyclooxygenase-2 released from fatty tissue have also been implicated in the development of accompanying asthma in obesity. [7] As the need for oxygen increases, total blood volume and stroke volume also increase. The stroke volume, in turn, increases the consumption of oxygen especially important in the obese patient.…”

Section: Biologic and Physiologic Properties Of The Obese Patientmentioning

confidence: 99%

“…long with plateu pressures of 40-55 cmH 2 O) and relatively lower oxygen values (FiO 2 %0.5-0.8 to prevent atelectasis and oxygen toxicity) as well asnormocarbia-adjusted ventilation values and keeping the patient in the head-up position are recommended. [7,22] As nasogastric tubes and bougies, dilators etc. may be used and repositioned several times during the operation, securing the airway tubes and the follow-up of secretions and bleeding are important.…”

Section: Intraoperative Management Of the Morbidly Obese Patientmentioning

confidence: 99%

Anesthesia for the surgical procedures of the morbidly obese

Pamuk¹

2017

Laparosc Endosc Surg Sci

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Surgery for the morbidly obese is no longer a novelty. Understanding the basic mechanisms of the pathophysiology of morbid obesity and taking simple precautions while preparing these patients for surgery will help reduce complications. This review outlined preoperative, perioperative, and postoperative management of the morbidly obese patient in line with the current knowledge. Airway management, drug choices, changes in respiratory, circulatory, urinary, and metabolic systems were discussed. Some early and long-term changes in the morbidly obese, like gastroesophageal reflux and vitamin deficiencies were also summarized to aid in subsequent operations and management.

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Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis

Cited by 155 publications

References 48 publications

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

Anesthesia for the surgical procedures of the morbidly obese

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