Document Detail


Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis.
MedLine Citation:
PMID:  18073547     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The authors studied the effects of the beach chair (BC) position, 10 cm H2O positive end-expiratory pressure (PEEP), and pneumoperitoneum on respiratory function in morbidly obese patients undergoing laparoscopic gastric banding. METHODS: The authors studied 20 patients (body mass index 42 +/- 5 kg/m2) during the supine and BC positions, before and after pneumoperitoneum was instituted (13.6 +/- 1.2 mmHg). PEEP was applied during each combination of position and pneumoperitoneum. The authors measured elastance (E,rs) of the respiratory system, end-expiratory lung volume (helium technique), and arterial oxygen tension. Pressure-volume curves were also taken (occlusion technique). Patients were paralyzed during total intravenous anesthesia. Tidal volume (10.5 +/- 1 ml/kg ideal body weight) and respiratory rate (11 +/- 1 breaths/min) were kept constant throughout. RESULTS: In the supine position, respiratory function was abnormal: E,rs was 21.71 +/- 5.26 cm H2O/l, and end-expiratory lung volume was 0.46 +/- 0.1 l. Both the BC position and PEEP improved E,rs (P < 0.01). End-expiratory lung volume almost doubled (0.83 +/- 0.3 and 0.85 +/- 0.3 l, BC and PEEP, respectively; P < 0.01 vs. supine zero end-expiratory pressure), with no evidence of lung recruitment (0.04 +/- 0.1 l in the supine and 0.07 +/- 0.2 in the BC position). PEEP was associated with higher airway pressures than the BC position (22.1 +/- 2.01 vs. 13.8 +/- 1.8 cm H2O; P < 0.01). Pneumoperitoneum further worsened E,rs (31.59 +/- 6.73; P < 0.01) and end-expiratory lung volume (0.35 +/- 0.1 l; P < 0.01). Changes of lung volume correlated with changes of oxygenation (linear regression, R2 = 0.524, P < 0.001) so that during pneumoperitoneum, only the combination of the BC position and PEEP improved oxygenation. CONCLUSIONS: The BC position and PEEP counteracted the major derangements of respiratory function produced by anesthesia and paralysis. During pneumoperitoneum, only the combination of the two maneuvers improved oxygenation.
Authors:
Franco Valenza; Federica Vagginelli; Alberto Tiby; Silvia Francesconi; Giulio Ronzoni; Massimiliano Guglielmi; Marco Zappa; Ezio Lattuada; Luciano Gattinoni
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  107     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-12-12     Completed Date:  2008-01-15     Revised Date:  2008-06-17    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  725-32     Citation Subset:  AIM; IM    
Affiliation:
Istituto di Anestesia e Rianimazione, Fondazione Ospedale Maggiore, Mangiagalli e Regina Elena-IRCCS, Milan, Italy. franco.valenza@unimi.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Intravenous
Blood Gas Analysis
Blood Pressure
Body Mass Index
Female
Gastroplasty / methods
Heart Rate
Humans
Laparoscopy
Lung Volume Measurements
Male
Obesity, Morbid / physiopathology,  surgery*
Oxygen / blood
Paralysis / chemically induced*
Pneumoperitoneum, Artificial / methods,  statistics & numerical data*
Positive-Pressure Respiration / methods,  statistics & numerical data*
Posture*
Respiration*
Supine Position
Tidal Volume
Chemical
Reg. No./Substance:
7782-44-7/Oxygen
Comments/Corrections
Comment In:
Anesthesiology. 2008 Jun;108(6):1153; author reply 1153-4   [PMID:  18497624 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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