Comparative Evaluation of the Effects of Three Different Recruitment Maneuvers during Laparoscopic Bariatric Surgeries of Morbid Obese Patients on Cardiopulmonary Indices

Document Type : Original Article

Authors

1 Department of Anesthesia, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Laparoscopic bariatric surgeries in morbid obese patients may be associated with atelectasis, hypercapnia, and hypoxemia, intra and postoperatively. Several strategies are used for the prevention of these consequences. This study aimed to examine the effects of three different recruitment maneuvers comparatively during surgery and the influence of the maneuvers on some cardiopulmonary indices. Materials and Methods: In a clinical trial, ninety participants of laparoscopic surgery with body mass index higher than 40 were randomly divided into three equal groups. The first group was subject to 10 cmH2O positive end-expiratory pressure (PEEP) during surgery, the second group, after venting the pneumoperitoneum, had 5 deep breaths with a positive pressure of 40 cmH2O, and the third group was subject to both. Some pulmonary and hemodynamic parameters were measured every 15 min and compared between three groups. Results: The average of peak airway pressure, plateau airway pressure, and SpO2static and dynamic compliance between the three groups had no meaningful differences (P > 0.05), but PaCO2in the second group was statistically higher than the other two groups (P < 0.05). Conclusion: Multiple deep breaths alone are not as effective as PEEP or PEEP plus MDB in preventing adverse pulmonary effects in laparoscopic bariatric surgeries of morbid obese patients.

Keywords

1.
Forgiarini Júnior LA, Rezende JC, Forgiarini SG. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery. Rev Bras Ter Intensiva 2013;25:312-8.  Back to cited text no. 1
    
2.
Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol 2010;108:206-11.  Back to cited text no. 2
[PUBMED]    
3.
Dumont L, Mattys M, Mardirosoff C, Vervloesem N, Allé JL, Massaut J. Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients. Acta Anaesthesiol Scand 1997;41:408-13.  Back to cited text no. 3
    
4.
Casati A, Comotti L, Tommasino C, Leggieri C, Bignami E, Tarantino F, et al. Effects of pneumoperitoneum and reverse Trendelenburg position on cardiopulmonary function in morbidly obese patients receiving laparoscopic gastric banding. Eur J Anaesthesiol 2000;17:300-5.  Back to cited text no. 4
[PUBMED]    
5.
Hedenstierna G, Edmark L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive Care Med 2005;31:1327-35.  Back to cited text no. 5
[PUBMED]    
6.
Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: Causes and measures to prevent it. J Clin Monit Comput 2000;16:329-35.  Back to cited text no. 6
[PUBMED]    
7.
Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 1996;109:144-51.  Back to cited text no. 7
[PUBMED]    
8.
Putensen-Himmer G, Putensen C, Lammer H, Lingnau W, Aigner F, Benzer H. Comparison of postoperative respiratory function after laparoscopy or open laparotomy for cholecystectomy. Anesthesiology 1992;77:675-80.  Back to cited text no. 8
[PUBMED]    
9.
Sprung J, Whalley DG, Falcone T, Wilks W, Navratil JE, Bourke DL. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth Analg 2003;97:268-74.  Back to cited text no. 9
[PUBMED]    
10.
Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici S, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999;91:1221-31.  Back to cited text no. 10
[PUBMED]    
11.
Perilli V, Sollazzi L, Bozza P, Modesti C, Chierichini A, Tacchino RM, et al. The effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg 2000;91:1520-5.  Back to cited text no. 11
[PUBMED]    
12.
Chalhoub V, Yazigi A, Sleilaty G, Haddad F, Noun R, Madi-Jebara S, et al. Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. Eur J Anaesthesiol 2007;24:283-8.  Back to cited text no. 12
[PUBMED]    
13.
Almarakbi WA, Fawzi HM, Alhashemi JA. Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients. Br J Anaesth 2009;102:862-8.  Back to cited text no. 13
[PUBMED]    
14.
Póvoa P, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H. Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. Acta Anaesthesiol Scand 2004;48:287-93.  Back to cited text no. 14
    
15.
Santa Cruz R, Rojas JI, Nervi R, Heredia R, Ciapponi A. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013;6:CD009098.  Back to cited text no. 15
    
16.
Choi YS, Bae MK, Kim SH, Park JE, Kim SY, Oh YJ. Effects of alveolar recruitment and positive end-expiratory pressure on oxygenation during one-lung ventilation in the supine position. Yonsei Med J 2015;56:1421-7.  Back to cited text no. 16
[PUBMED]    
17.
Pirrone M, Fisher D, Chipman D, Imber DA, Corona J, Mietto C, et al. Recruitment maneuvers and positive end-expiratory pressure titration in morbidly obese ICU patients. Crit Care Med 2016;44:300-7.  Back to cited text no. 17
[PUBMED]    
18.
Futier E, Constantin JM, Pelosi P, Chanques G, Kwiatkoskwi F, Jaber S, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology 2010;113:1310-9.  Back to cited text no. 18
[PUBMED]    
19.
de Souza AP, Buschpigel M, Mathias LA, Malheiros CA, Alves VL. Analysis of the effects of the alveolar recruitment maneuver on blood oxygenation during bariatric surgery. Rev Bras Anestesiol 2009;59:177-86.  Back to cited text no. 19
[PUBMED