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Mato-Búa R, Prado-Rodríguez A, López-López D, Rama-Maceiras P, Molins-Gauna N, Álvarez-Refojo F. Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:151-159. [PMID: 38452926 DOI: 10.1016/j.redare.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. METHODS Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min. RESULTS Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied. CONCLUSION In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.
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Affiliation(s)
- R Mato-Búa
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
| | - A Prado-Rodríguez
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - D López-López
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - P Rama-Maceiras
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - N Molins-Gauna
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - F Álvarez-Refojo
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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Aboseif A, Bedewy A, Nafei M, Hammad R, Amin S. Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study. Anesth Pain Med 2023; 13:e128440. [PMID: 37645008 PMCID: PMC10461388 DOI: 10.5812/aapm-128440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 08/31/2023] Open
Abstract
Background Morbid obesity may cause a restrictive condition. General anesthesia (GA) and supine posture both decrease lung capacity and functional residual capacity (FRC), altering the ventilation/perfusion ratio and raising the pulmonary shunt. Objectives To evaluate the impact of recruitment maneuver (RM) and transversus abdominis plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, opioid requirements, and pain score assessed after surgery. Methods This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients received a standardized postoperative analgesia regimen. Group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal insufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results Forced vital capacity (FVC) and forced expiratory volume (FEV1) were significantly higher after group IV operation than in other groups. Intraoperative PaO2 and PaO2/FiO2 were significantly higher in groups III and IV compared to other groups. The numerical rating scale (NRS) at 1, 2, 4, 6, and 12h was significantly decreased in groups II and IV compared to other groups. Morphine consumption was significantly lower in groups II and IV compared to other groups. Conclusions TAP block combined with RM had better postoperative pulmonary function tests. Intraoperative oxygenation was higher in RM.
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Affiliation(s)
| | - Ahmed Bedewy
- Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Magdy Nafei
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Raafat Hammad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Salwa Amin
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Bolther M, Henriksen J, Holmberg MJ, Jessen MK, Vallentin MF, Hansen FB, Holst JM, Magnussen A, Hansen NS, Johannsen CM, Enevoldsen J, Jensen TH, Roessler LL, Carøe Lind P, Klitholm MP, Eggertsen MA, Caap P, Boye C, Dabrowski KM, Vormfenne L, Høybye M, Karlsson M, Balleby IR, Rasmussen MS, Pælestik K, Granfeldt A, Andersen LW. Ventilation Strategies During General Anesthesia for Noncardiac Surgery: A Systematic Review and Meta-Analysis. Anesth Analg 2022; 135:971-985. [PMID: 35703253 DOI: 10.1213/ane.0000000000006106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal ventilation strategy during general anesthesia is unclear. This systematic review investigated the relationship between ventilation targets or strategies (eg, positive end-expiratory pressure [PEEP], tidal volume, and recruitment maneuvers) and postoperative outcomes. METHODS PubMed and Embase were searched on March 8, 2021, for randomized trials investigating the effect of different respiratory targets or strategies on adults undergoing noncardiac surgery. Two investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and several subgroup analyses were conducted. The certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS This review included 63 trials with 65 comparisons. Risk of bias was intermediate for all trials. In the meta-analyses, lung-protective ventilation (ie, low tidal volume with PEEP) reduced the risk of combined pulmonary complications (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.28-0.49; 9 trials; 1106 patients), atelectasis (OR, 0.39; 95% CI, 0.25-0.60; 8 trials; 895 patients), and need for postoperative mechanical ventilation (OR, 0.36; 95% CI, 0.13-1.00; 5 trials; 636 patients). Recruitment maneuvers reduced the risk of atelectasis (OR, 0.44; 95% CI, 0.21-0.92; 5 trials; 328 patients). We found no clear effect of tidal volume, higher versus lower PEEP, or recruitment maneuvers on postoperative pulmonary complications when evaluated individually. For all comparisons across targets, no effect was found on mortality or hospital length of stay. No effect measure modifiers were found in subgroup analyses. The certainty of evidence was rated as very low, low, or moderate depending on the intervention and outcome. CONCLUSIONS Although lung-protective ventilation results in a decrease in pulmonary complications, randomized clinical trials provide only limited evidence to guide specific ventilation strategies during general anesthesia for adults undergoing noncardiac surgery.
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Affiliation(s)
- Maria Bolther
- From the Department of Anesthesiology and Intensive Care
| | | | - Mathias J Holmberg
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Marie K Jessen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikael F Vallentin
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | | | | | | | | | | | | | - Thomas H Jensen
- Department of Internal Medicine, University Hospital of North Norway, Narvik, Norway
| | - Lara L Roessler
- Department of Emergency Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Mark A Eggertsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philip Caap
- From the Department of Anesthesiology and Intensive Care
| | - Caroline Boye
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lasse Vormfenne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Høybye
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Karlsson
- Anesthesiology and Intensive Care, Aalborg University Hospital, Denmark
| | - Ida R Balleby
- National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Marie S Rasmussen
- Anesthesiology and Intensive Care, Aalborg University Hospital, Denmark
| | - Kim Pælestik
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Asger Granfeldt
- From the Department of Anesthesiology and Intensive Care.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars W Andersen
- From the Department of Anesthesiology and Intensive Care.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
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Pei S, Wei W, Yang K, Yang Y, Pan Y, Wei J, Yao S, Xia H. Recruitment Maneuver to Reduce Postoperative Pulmonary Complications after Laparoscopic Abdominal Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195841. [PMID: 36233708 PMCID: PMC9573602 DOI: 10.3390/jcm11195841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Lung-protective ventilation strategies are recommended for patients undergoing mechanical ventilation. However, there are currently no guidelines to follow regarding recruitment maneuvers (RMs). We attempted to identify the effects of RMs on patients undergoing laparoscopic abdominal surgery. Methods: We searched for randomized controlled trials (RCTs) in PubMed, the Cochrane Library databases, Embase, Web of Science and the ClinicalTrials.gov registry for trials published up to December 2021. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes consisted of the static lung compliance, driving pressure (DP), intraoperative oxygenation index (OI), OI in the post-anesthesia care unit (PACU), mean arterial pressure (MAP) and heart rate (HR). Seventeen RCTs with a total of 3480 patients were examined. Results: Patients who received RMs showed a considerable reduction in PPCs (risk ratio (RR) = 0.70; 95% confidence interval (CI): 0.62 to 0.79; p < 0.01), lower DP (weighted mean difference (WMD) = −3.96; 95% CI: −5.97 to −1.95; p < 0.01), elevated static lung compliance (WMD = 10.42; 95% CI: 6.13 to 14.71; p < 0.01) and improved OI (intraoperative: WMD = 53.54; 95% CI: 21.77 to 85.31; p < 0.01; PACU: WMD = 59.40; 95% CI: 39.10 to 79.69; p < 0.01) without substantial changes in MAP (WMD = −0.16; 95% CI −1.35 to 1.03; p > 0.05) and HR (WMD = −1.10; 95% CI: −2.29 to 0.10; p > 0.05). Conclusions: Recruitment maneuvers reduce postoperative pulmonary complications and improve respiratory mechanics and oxygenation in patients undergoing laparoscopic abdominal surgery. More data are needed to elucidate the effect of recruitment maneuver on the circulatory system.
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Affiliation(s)
- Shuaijie Pei
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei Wei
- Department of Anesthesiology, The People’s Hospital of Honghu, Honghu 433200, China
| | - Kai Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yiyi Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Pan
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jinrui Wei
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (S.Y.); (H.X.)
| | - Haifa Xia
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Anesthesiology, The People’s Hospital of Honghu, Honghu 433200, China
- Department of Critical Care Medicine, The People’s Hospital of Honghu, Honghu 433200, China
- Correspondence: (S.Y.); (H.X.)
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Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ 2020; 368:m540. [PMID: 32161042 PMCID: PMC7190038 DOI: 10.1136/bmj.m540] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS 117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONS Predominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGISTRATION Prospero CRD42016035662.
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Affiliation(s)
- Peter M Odor
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - Sohail Bampoe
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - David Gilhooly
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - Benedict Creagh-Brown
- Surrey Perioperative Anaesthesia Critical care collaborative Research (SPACeR) Group, Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - S Ramani Moonesinghe
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
- UCL/UCLH Surgical Outcomes Research Centre, UCL Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
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Costa Souza GM, Santos GM, Zimpel SA, Melnik T. Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis. BMC Anesthesiol 2020; 20:36. [PMID: 32019491 PMCID: PMC7001296 DOI: 10.1186/s12871-020-0936-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 01/10/2020] [Indexed: 01/12/2023] Open
Abstract
Background Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition. Objective To assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery. Methods A systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations. Results Fourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenation p = 0.03 (MD 79.93), higher plateau pressure p < 0.00001 (MD 7.30), higher mean airway pressure p < 0.00001 (MD 6.61), and higher compliance p < 0.00001 (MD 21.00); when comparing RM + Zero end-expiratory pressure (ZEEP) vs RM + PEEP 5 or 10 cmH2O, RM associated with PEEP led to better oxygenation p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchange p = 0.003 (MD 36.00) and compliance p = 0.0003 (MD 3.00). Conclusion There is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).
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Affiliation(s)
- George Márcio Costa Souza
- Universidade Estadual de Ciências da Saúde de Alagoas - Uncisal. Pró-Reitoria de Ensino e Graduação, Rua Jorge de Lima, N 113, Trapiche, Maceió-Al, Maceio, Alagoas, 57010-382, Brazil.
| | - Gianni Mara Santos
- Universidade Federal de São Paulo - Unifesp, Pró Reitoria de Pós-Graduação, Rua Botucatu, 740 3° andar Sala 305, Vila Clementino, Sao Paulo, Brazil
| | - Sandra Adriana Zimpel
- Universidade Estadual de Ciências da Saúde de Alagoas - Uncisal. Pró-Reitoria de Ensino e Graduação, Rua Jorge de Lima, N 113, Trapiche, Maceió-Al, Maceio, Alagoas, 57010-382, Brazil
| | - Tamara Melnik
- Universidade Federal de São Paulo - Unifesp. Programa de Pos-graduacao em Saude Baseada em Evidências, Rua Botucatu, 740 3° andar Sala 305, Vila Clementino, Sao Paulo, SP, 04023-900, Brazil
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Pazzianotto-Forti EM, Baltieri L, Brigatto P, Costa CMD, Rocha MRSD, Rasera-Júnior I. Bilevel positive airway pressure in two moments after bariatric surgery. ACTA ACUST UNITED AC 2019; 65:1161-1167. [PMID: 31618331 DOI: 10.1590/1806-9282.65.9.1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.
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Affiliation(s)
- Eli Maria Pazzianotto-Forti
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Letícia Baltieri
- . Doutorado em Ciências da Cirurgia, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil
| | - Patrícia Brigatto
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Carolina Moraes da Costa
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Maura Rigoldi Simões da Rocha
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Irineu Rasera-Júnior
- . Doutorado em Bases Gerais da Cirurgia, Centro de Gastroenterologia e Cirurgia da Obesidade, Piracicaba, SP, Brasil
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Kazakova T, Hammond B, Talarek C, Sinha AC, Brister NW. Anesthetic Management for Paraesophageal Hernia Repair. Thorac Surg Clin 2019; 29:447-455. [PMID: 31564402 DOI: 10.1016/j.thorsurg.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Paraesophageal hernia repairs are complex surgical cases frequently performed on patients of advanced age with multiple comorbidities, both of which create difficulties in the anesthetic management. Preoperative evaluation is challenging because of overlapping cardiopulmonary symptoms. The patient's symptoms and anatomy lead to an increased aspiration risk and the potential need for a rapid sequence induction. Depending on the surgical approach, lung isolation may be required. Communication with the surgeon is vital throughout the case, especially when placing gastric tube and bougies. Multimodal analgesia should include regional and/or neuraxial techniques, in addition to the standard intravenous and oral pain medications.
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Affiliation(s)
- Tatiana Kazakova
- Department of Family Medicine, Jefferson Health NE, 10800 Knights Road, Philadelphia, PA 19114, USA
| | - Bradley Hammond
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Chad Talarek
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Ashish C Sinha
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Neil W Brister
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B307 Outpatient Building Floor, Philadelphia, PA 19140, USA.
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Grant MC, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, McEvoy MD, King AB, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Anesth Analg 2019; 129:51-60. [DOI: 10.1213/ane.0000000000003696] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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10
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Cavalcanti MGDO, Andrade LB, Santos PCPD, Lucena LRR. NON-INVASIVE PREVENTIVE VENTILATION WITH TWO PRESSURE LEVELS IN THE POSTOPERATIVE PERIOD OF ROUX-EN-Y GASTRIC BYPASS: RANDOMIZED TRIAL. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1361. [PMID: 29947695 PMCID: PMC6049999 DOI: 10.1590/0102-672020180001e1361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. AIM To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. METHODS This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. RESULTS Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. CONCLUSION It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.
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Baltieri L, Peixoto‐Souza FS, Rasera‐Junior I, Montebelo MIDL, Costa D, Pazzianotto‐Forti EM. Análise da prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica. Rev Bras Anestesiol 2016; 66:577-582. [DOI: 10.1016/j.bjan.2015.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022] Open
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Preoxygenation and intraoperative ventilation strategies in obese patients: a comprehensive review. Curr Opin Anaesthesiol 2016; 29:109-18. [PMID: 26545146 DOI: 10.1097/aco.0000000000000267] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Obesity along with its pathophysiological changes increases risk of intraoperative and perioperative respiratory complications. The aim of this review is to highlight recent updates in preoxygenation techniques and intraoperative ventilation strategies in obese patients to optimize gas exchange and pulmonary mechanics and reduce pulmonary complications. RECENT FINDINGS There is no gold standard in preoxygenation or intraoperative ventilatory management protocol for obese patients. Preoxygenation in head up or sitting position has been shown to be superior to supine position. Apneic oxygenation and use of continuous positive airway pressure increases safe apnea duration. Recent evidence encourages the intraoperative use of low tidal volume to improve oxygenation and lung compliance without adverse effects. Contrary to nonobese patients, some studies have reported the beneficial effect of recruitment maneuvers and positive end-expiratory pressure in obese patients. No difference has been observed between volume controlled and pressure controlled ventilation. SUMMARY The ideal ventilatory plan for obese patients is indeterminate. A multimodal preoxygenation and intraoperative ventilation plan is helpful in obese patients to reduce perioperative respiratory complications. More studies are needed to identify the role of low tidal volume, positive end-expiratory pressure, and recruitment maneuvers in obese patients undergoing general anesthesia.
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Baltieri L, Peixoto-Souza FS, Rasera-Junior I, Montebelo MIDL, Costa D, Pazzianotto-Forti EM. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery. Braz J Anesthesiol 2015; 66:577-582. [PMID: 27793232 DOI: 10.1016/j.bjane.2014.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/26/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.
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Affiliation(s)
- Letícia Baltieri
- Universidade Estadual de Campinas (Unicamp), Programa de Pós-Graduação em Ciências da Cirurgia, Campinas, SP, Brazil
| | - Fabiana Sobral Peixoto-Souza
- Universidade Nove de Julho (Uninove), Programa de Pós-Graduação em Ciências da Reabilitação, São Paulo, SP, Brazil
| | | | | | - Dirceu Costa
- Universidade Nove de Julho (Uninove), Programa de Pós-Graduação em Ciências da Reabilitação, São Paulo, SP, Brazil; Universidade Federal de São Carlos (UFSCar), Programa de Pós-Graduação em Fisioterapia, São Carlos, SP, Brazil
| | - Eli Maria Pazzianotto-Forti
- Universidade Metodista de Piracicaba (Unimep), Programa de Pós-Graduação em Ciências do Movimento Humano, Piracicaba, SP, Brazil.
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Baltieri L, Santos LA, Rasera I, Montebelo MIL, Pazzianotto-Forti EM. Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27 Suppl 1:26-30. [PMID: 25409961 PMCID: PMC4743514 DOI: 10.1590/s0102-6720201400s100007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/13/2014] [Indexed: 01/07/2023]
Abstract
Background In surgical procedures, obesity is a risk factor for the onset of intra and
postoperative respiratory complications. Aim Determine what moment of application of positive pressure brings better benefits
on lung function, incidence of atelectasis and diaphragmatic excursion, in the
preoperative, intraoperative or immediate postoperative period. Method Randomized, controlled, blinded study, conducted in a hospital and included
subjects with BMI between 40 and 55 kg/m2, 25 and 55 years, underwent
bariatric surgery by laparotomy. They were underwent preoperative and
postoperative evaluations. They were allocated into four different groups: 1)
Gpre: treated with positive pressure in the BiPAP mode (Bi-Level Positive Airway
Pressure) before surgery for one hour; 2) Gpos: BIPAP after surgery for one hour;
3) Gintra: PEEP (Positive End Expiratory Pressure) at 10 cmH2O during
the surgery; 4) Gcontrol: only conventional respiratory physiotherapy. The
evaluation consisted of anthropometric data, pulmonary function tests and chest
radiography. Results Were allocated 40 patients, 10 in each group. There were significant differences
for the expiratory reserve volume and percentage of the predicted expiratory
reserve volume, in which the groups that received treatment showed a smaller loss
in expiratory reserve volume from the preoperative to postoperative stages. The
postoperative radiographic analysis showed a 25% prevalence of atelectasis for
Gcontrol, 11.1% for Gintra, 10% for Gpre, and 0% for Gpos. There was no
significant difference in diaphragmatic mobility amongst the groups. Conclusion The optimal time of application of positive pressure is in the immediate
postoperative period, immediately after extubation, because it reduces the
incidence of atelectasis and there is reduction of loss of expiratory reserve
volume.
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Affiliation(s)
| | | | - Irineu Rasera
- Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
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Utilização da pressão positiva no pré e no intraoperatório de cirurgia bariátrica e seus efeitos sobre o tempo de extubação. Braz J Anesthesiol 2015; 65:130-5. [DOI: 10.1016/j.bjan.2013.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/31/2013] [Indexed: 11/20/2022] Open
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Forgiarini Júnior LA, Rezende JC, Forgiarini SGI. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery. Rev Bras Ter Intensiva 2014; 25:312-8. [PMID: 24553513 PMCID: PMC4031868 DOI: 10.5935/0103-507x.20130053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/12/2013] [Indexed: 11/20/2022] Open
Abstract
The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described.
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Affiliation(s)
- Luiz Alberto Forgiarini Júnior
- Centro Universitário Metodista - IPA, Porto AlegreRS, Brasil, Centro Universitário Metodista - IPA - Porto Alegre (RS), Brasil
| | - Juliana Castilhos Rezende
- Complexo Hospitalar Santa Casa de Porto Alegre, Porto AlegreRS, Brasil, Complexo Hospitalar Santa Casa de Porto Alegre - Porto Alegre (RS), Brasil
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