Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-19T16:47:17.264Z Has data issue: false hasContentIssue false
  • English
  • Français

Respiratory mechanics in morbid obese patients with chronic obstructive pulmonary disease and hypertension during pneumoperitoneum

Published online by Cambridge University Press:  12 July 2005

Z. Salihoglu ,
S. Demiroluk  and
Y. Dikmen
Z. Salihoglu
Affiliation:
Istanbul Universitesi, Cerrahpasa Tip Fakultesi, Anestezi Anabilimdali, Istanbul, Turkey
S. Demiroluk
Affiliation:
Istanbul Universitesi, Cerrahpasa Tip Fakultesi, Anestezi Anabilimdali, Istanbul, Turkey
Y. Dikmen
Affiliation:
Istanbul Universitesi, Cerrahpasa Tip Fakultesi, Anestezi Anabilimdali, Istanbul, Turkey
Get access

Abstract

Summary

Background and objective: To evaluate the effects of pneumoperitoneum and the reverse Trendelenburg position on respiratory mechanics and blood-gases in morbid obese patients with chronic obstructive pulmonary disease and hypertension.

Methods: Sixteen morbid obese patients with chronic obstructive pulmonary disease and hypertension were studied. Mean arterial pressure, heart rate, respiratory resistance, dynamic respiratory compliance and peak inspiratory pressures were measured at four time points: 5 min after induction of anaesthesia (T1), 5 min after insufflation of the peritoneum (T2), 5 min after adoption of a 20° reverse Trendelenburg position (T3), and 5 min after deflation of the peritoneum (T4). Arterial blood-gas status was measured at the same measuring points.

Results: Respiratory compliance was 40 ± 12, 28 ± 8, 32 ± 8 and 37 ± 11 mL cmH2O−1 in T1, T2, T3 and T4, respectively. The changes were significant at T2, T3 and T4. Airway resistance and peak inspiratory pressures showed comparable changes throughout the study with that of respiratory compliance. Haemodynamic measurements showed no clinically significant changes in this study.

Conclusions: In morbid obese patients with chronic obstructive pulmonary disease and hypertension, a 20° reverse Trendelenburg position improved respiratory mechanics and oxygenation without any apparent adverse effects on haemodynamics during laparoscopic gastric banding surgery.

Keywords

LUNG DISEASES, OBSTRUCTIVE, chronic obstructive, pulmonary diseaseOBESITY, morbid, obesityPOSTURE, head-up tiltRESPIRATION, lung compliance, respiratory mechanicsVASCULAR DISEASES, hypertension
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 8 , September 2003 , pp. 658 - 661
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bray GA. Classification and evaluation of obesities. Med Clin North Am 1989; 73: 161–184.Google Scholar
Auler JOC, Miyoshi E, Fernandes CR, Bensenor FE, Elias L, Bonassa J. The effects of abdominal opening on respiratory mechanics during general anaesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg 2002; 94: 741–748.Google Scholar
Buckley FP. Anaesthesia for morbidly obese patient. Can J Anaesth 1994; 41: 94–100.Google Scholar
Oberg B, Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand 1996; 40: 191–200.Google Scholar
Perilli V. Sollazzi L, Bozza P, et al. The effects of the reverse Trendelenburg position on respiratory mechanics and blood gases in morbid obese patients during bariatric surgery. Anesth Analg 2000; 91: 1520–1523.Google Scholar
Joris JL, Hinque VL, Laurent PE, Desaive CJ, Lamy ML. Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbid obese patients. Br J Anaesth 1998; 80: 238–288.Google Scholar
Casati A, Comotti L, Tommasino C, et al. Effects of pneumoperitoneum and reverse Trendelenburg on cardiopulmonary function in morbid obese patients receiving laparoscopic gastric banding. Eur J Anaesthesiol 2000; 17: 300–305.Google Scholar
Gomez FP, Rodriguez-Roisin R. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease. Curr Opin Pulm Med 2002; 8: 81–86.Google Scholar
Servin F, Farinotti R, Haberer JP. Propofol infusion for maintenance of anaesthesia in morbid obese patients receiving nitrous oxide. A clinical and pharmacokinetic study. Anesthesiology 1993; 78: 657–665.Google Scholar
National Institutes of Health consensus development conference statement. Gastrointestinal surgery for severe obesity. Obes Surg 1991; 1: 257–266.
Kelman GR, Swapp GH, Smith I, Benzie RJ, Gordon NL. Cardiac output and arterial blood-gas tension during laparoscopy. Br J Anaesth 1972; 44: 1155–1162.Google Scholar
Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anaesthesia. Anesth Analg 1998; 87: 654–660.Google Scholar
Dumont L, Mattys M, Mardirosoff C, Vervlosem N, Alle JL, Massaut J. Changes in pulmonary mechanics during laparoscopic gastroplasty in morbid obese patients. Acta Anaesthesiol Scand 1997; 41: 408–414.Google Scholar
Rothen HU, Sporre B, Engbert G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Anaesthesia 1993; 71: 788–795.Google Scholar
Sprung J, Whalley DG, Falcone T, Warner DO, Hubmayr RD, Hammel J. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 2002; 94: 1345–1350.Google Scholar
Vaughan RW, Wise L. Intraoperative arterial oxygenation in obese patients. Ann Surg 1976; 184: 35–41.Google Scholar