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BJA Advance Access published online on November 19, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep319
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery

T. N. Weingarten1, F. X. Whalen1, D. O. Warner1, O. Gajic2, G. J. Schears1, M. R. Snyder3, D. R. Schroeder4 and J. Sprung1,*

1 Department of Anesthesiology and Anesthesia Clinical Research Unit,
2 Department of Pulmonary and Critical Care Medicine,
3 Department of Laboratory Medicine and Medical Pathology and
4 Department of Health Sciences Research (Statistician), College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

* Corresponding author. E-mail: sprung.juraj{at}mayo.edu

Background: ‘Open lung’ ventilation is commonly used in patients with acute lung injury and has been shown to improve intraoperative oxygenation in obese patients undergoing laparoscopic surgery. The feasibility of an ‘open lung’ ventilatory strategy in elderly patients under general anaesthesia has not previously been assessed.

Methods: ‘Open lung’ ventilation (recruitment manoeuvres, tidal volume 6 ml kg–1 predicted body weight, and 12 cm H2O PEEP) (RM group) was compared with conventional ventilation (no recruitment manoeuvres, tidal volume 10 ml kg–1 predicted body weight, and zero end-expiratory pressure) in elderly patients (>65 yr) undergoing major open abdominal surgery with regard to oxygenation, respiratory system mechanics, and haemodynamic stability. We also monitored the serum levels of the interleukins (IL)-6 and IL-8 before and after surgery to determine whether the systemic inflammatory response to surgery depends on the ventilatory strategy used.

Results: Twenty patients were included in each group. The RM group tolerated open lung ventilation without significant haemodynamic instability. Intraoperative PaO2 improved in the RM group (P<0.01) and deteriorated in controls (P=0.01), but postoperative PaO2 was similar in both groups. The RM group had improved breathing mechanics as evidenced by increased dynamic compliance (36%) and decreased airway resistance (21%). Both IL-6 and IL-8 significantly increased after surgery, but the magnitude of increase did not differ between the groups.

Conclusions: A lung recruitment strategy in elderly patients is well tolerated and improves intraoperative oxygenation and lung mechanics during laparotomy.

Keywords: aged; anaesthesia, general; positive-pressure respiration; surgery; ventilation, mechanical


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