Document Detail

Beneficial effects of high positive end-expiratory pressure in lung respiratory mechanics during laparoscopic surgery.
MedLine Citation:
PMID:  19175578     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The effect of neuromuscular blockade (NMB) and positive end-expiratory pressure (PEEP) on the elastic properties of the respiratory system during pneumoperitoneum (PnP) remains a controversial subject. The main objective of the present study was to evaluate the effects of NMB and PEEP on respiratory mechanics. METHODS: We performed a dynamic analysis of respiratory mechanics in patients subjected to PnP. Twenty-one patients underwent cholecystectomy videolaparoscopy and total intravenous anesthesia. The respiratory system resistance (R(RS)), pulmonary elastance (E(P)), chest wall elastance (E(CW)), and respiratory system elastance (E(RS)) were computed via the least squares fit technique using an equation describing the motion of the respiratory system, which uses primary signs such as airway pressure, tidal volume, air flow, and esophageal pressures. Measurements were taken after tracheal intubation, PnP, NMB, establishment of PEEP (10 cmH2O), and PEEP withdrawal [zero end-expiratory pressure (ZEEP)]. RESULTS: PnP significantly increased E(RS) by 27%; both E(P) and E(CW) increased 21.3 and 64.1%, respectively (P < 0.001). NMB did not alter the respiratory mechanic properties. Setting PEEP reduced E(RS) by 8.6% (P < 0.05), with a reduction of 10.9% in E(P) (P < 0.01) and a significant decline of 15.7% in R(RS) (P < 0.05). These transitory changes in elastance disappeared after ZEEP. CONCLUSIONS: We concluded that the 10 cmH2O of PEEP attenuates the effects of PnP in respiratory mechanics, lowering R(RS), E(P), and E(RS). These effects may be useful in the ventilatory approach for patients experiencing a non-physiological increase in IAP owing to PnP in laparoscopic procedures.
L F Maracajá-Neto; N Verçosa; A C Roncally; A Giannella; F A Bozza; M A Lessa
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  53     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-29     Completed Date:  2009-03-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  210-7     Citation Subset:  IM    
Service of Anesthesiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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MeSH Terms
Anesthesia, Intravenous
Anoxia / etiology,  therapy*
Cholecystectomy, Laparoscopic*
Middle Aged
Neuromuscular Blockade
Pneumoperitoneum, Artificial / adverse effects*
Positive-Pressure Respiration / methods*
Pulmonary Atelectasis / prevention & control*
Respiratory Mechanics*
Video-Assisted Surgery

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