Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study.
DEFRESNE, Aline; HANS, Grégory; GOFFIN, Pierreet al.
2014 • In British Journal of Anaesthesia, 113 (3), p. 501-7
[en] BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass. METHODS: After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg(-1) of IBW) were randomly ventilated with either 10 cm H(2)O PEEP or with 10 cm H(2)O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea-hypopnoea index (AHI) were recorded during the first postoperative night. RESULTS: Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups (P=0.35). FVC, FEV1, mean [Formula: see text], percentage of time spent with [Formula: see text] below 90%, and AHI did not differ significantly between the groups. CONCLUSIONS: This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery. CLINICAL TRIAL REGISTRATION: EudraCT 2011-000999-33.
Disciplines :
Anesthesia & intensive care
Author, co-author :
DEFRESNE, Aline ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
HANS, Grégory ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
GOFFIN, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
BINDELLE, Simon ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
AMABILI, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
De Roover, Arnaud ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Poirrier, Robert ; Université de Liège - ULiège > Département des sciences cliniques > Médecine du sommeil
Brichant, Jean-François ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
JORIS, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Language :
English
Title :
Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study.
Publication date :
2014
Journal title :
British Journal of Anaesthesia
ISSN :
0007-0912
eISSN :
1471-6771
Publisher :
Elsevier, London, United Kingdom
Volume :
113
Issue :
3
Pages :
501-7
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Wahba R. Perioperative functional residual capacity. Can J Anaesth 1991; 3: 384-400
Hedenstierna G, Edmark L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive Care Med 2005; 10: 1327-35
Craig D. Postoperative recovery of pulmonary function. Anesth Analg 1981; 1: 46-52
Meyers J, Lembeck L, O'Kane H, Baue A. Changes in functional residual capacity of the lung after operation. Arch Surg 1975; 5: 576-83
Milic-Emili J, Torchio R, D'Angelo E. Closing volume: a reappraisal (1967-2007). Eur J Appl Physiol 2007; 6: 567-83
Eichenberger A, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 6: 1788-92, table
Tagaito Y, Isono S, Remmers J, Tanaka A, Nishino T. Lungvolumeand collapsibility of the passive pharynx in patients with sleepdisordered breathing. J Appl Physiol 2007; 4: 1379-85
Rose D, Cohen M, Wigglesworth D, Deboer D. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 1994; 2: 410-8
Wakefield H, Vaughan-Sarrazin M, Cullen J. Influence of obesity on complications and costs after intestinal surgery. AmJ Surg 2012; 4: 434-40
Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005; 6: 1110-5; discussion 5A
Rusca M, Proietti S, Schnyder P, et al. Prevention of atelectasis formation during induction of general anesthesia. Anesth Analg 2003; 6: 1835-9
Coussa M, Proietti S, Schnyder P, et al. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 2004; 5: 1491-5, table of contents
Reinius H, Jonsson L, Gustafsson S, et al. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology 2009; 5: 979-87
Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 1993; 6: 788-95
Futier E, Constantin J, Pelosi P, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology 2010; 6: 1310-9
Whalen FX, Gajic O, Thompson GB, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006; 1: 298-305
Bohm S, Thamm O, Von Sandersleben A, et al. Alveolar recruitment strategy and high positive end-expiratory pressure levels do not affect hemodynamics in morbidly obese intravascular volumeloaded patients. Anesth Analg 2009; 1: 160-3
Joris J, Kaba A, Lamy M. Postoperative spirometryafter laparoscopy for lower abdominal or upper abdominal surgical procedures. Br J Anaesth 1997; 4: 422-6
Joris J, Hinque V, Laurent P, Desaive C, Lamy M. Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients. Br J Anaesth 1998; 3: 283-8
Ebeo C, Benotti P, Byrd RJ, Elmaghraby Z, Lui J. The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. Respir Med 2002; 9: 672-6
Johnson D, Litwin D, Osachoff J, et al. Postoperative respiratory function after laparoscopic cholecystectomy. Surg Laparosc Endosc 1992; 3: 221-6
Damia G, Mascheroni D, Croci M, Tarenzi L. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth 1988; 5: 574-8
Karayiannakis A, Makri G, Mantzioka A, Karousos D, Karatzas G. Postoperative pulmonary function after laparoscopic and open cholecystectomy. Br J Anaesth 1996; 4: 448-52
Futier E, Constantin J, Pelosi P, et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 2011; 6: 1354-63.
Ali J, Gana T. Lungvolumes24hafter laparoscopic cholecystectomy- justification for early discharge. Can Respir J 1998; 2: 109-13
Severgnini P, Selmo G, Lanza C, et al. Protectivemechanicalventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology 2013; 6: 1307-21
Vaughan R, Wise L. Postoperative arterial blood gas measurement in obese patients: effect of position on gas exchange. Ann Surg 1975; 6: 705-9
Rosenberg J. Sleep disturbances after non-cardiac surgery. Sleep Med Rev 2001; 2: 129-37
Rosenberg J, Rasmussen G, Wojdemann K, Kirkeby L, Jorgensen L, Kehlet H. Ventilatory pattern and associated episodic hypoxaemia in the late postoperative period in the general surgicalward. Anaesthesia 1999; 4: 323-8
Lehrman S, Limann B, Koshy A, Aronow W, Ahn C, Maguire G. Association of lung volumes with nocturnal oxygen saturation in obese persons: a possible role for therapeutic continuous positive airway pressure. Am J Ther 2008; 3: 221-4
Almarakbi W, Fawzi H, Alhashemi J. Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients. Br J Anaesth 2009; 6: 862-8
Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth 2009; 11: 819-28
Isono S. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anesthesiology 2009; 4: 908-21
Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 2012; 5: 768-75
Cinnella G, Grasso S, Spadaro S, et al. Effects of recruitment maneuver and positive end-expiratory pressure on respiratory mechanics and transpulmonary pressure during laparoscopic surgery. Anesthesiology 2013; 1: 114-22