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BJA Advance Access published online on April 29, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep084
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients

W. A. Almarakbi1, H. M. Fawzi1 and J. A. Alhashemi2,*

1 Department of Anesthesia, Ain Shams University, Cairo, Egypt
2 Department of Anesthesia and Critical Care, King Abdulaziz University, PO Box 31648, Jeddah 21418, Saudi Arabia

* Corresponding author. E-mail: jalhashemi{at}kau.edu.sa

Background: Respiratory function is impaired in obese patients undergoing laparoscopic surgery. This study was performed to determine whether repeated lung recruitment combined with PEEP improves respiratory compliance and arterial partial pressure of oxygen (PaO2) in obese patients undergoing laparoscopic gastric banding.

Methods: Sixty patients with BMI >30 kg m–2 were randomized, after induction of pneumoperitoneum, to receive either PEEP of 10 cm H2O (Group P), inspiratory pressure of 40 cm H2O for 15 s once (Group R), Group R recruitment followed by PEEP 10 cm H2O (Group RP), or Group RP recruitment but with the inspiratory manoeuvre repeated every 10 min (Group RRP). Static respiratory compliance and PaO2 were determined after intubation, 10 min after pneumoperitoneum (before lung recruitment), and every 10 min thereafter (after recruitment). Results are presented as mean (SD).

Results: Pneumoperitoneum decreased respiratory compliance from 48 (3) to 30 (1) ml cm H2O–1 and decreased PaO2 from 12.4 (0.3) to 8.8 (0.3) kPa in all groups (P<0.01). Immediately after recruitment, compliance was 32 (1), 32 (2), 40 (2), and 40 (1) ml cm H2O–1 and PaO2 was 9.1 (0.3), 9.1 (0.1), 11.9 (0.1), and 11.9 (0.1) kPa in Groups P, R, RP, and RRP, respectively (P<0.01). Ten and 20 min later, PaO2 in Group R decreased to 9.2 (0.1) kPa and compliance in Group PR decreased to 33 (2) ml cm H2O–1, respectively (P<0.01).

Conclusions: Group RRP recruitment strategy was associated with the best intraoperative respiratory compliance and PaO2 in obese patients undergoing laparoscopic gastric banding.

Keywords: laparoscopy; lung, atelectasis; lung, compliance; lung, gas exchange, respiratory; obesity; oxygen, partial pressure; ventilation, positive end-expiratory pressure


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