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Youssef AM, El-Ozairy HS, El-Hennawy AM, Amer AM. Inverse ratio ventilation versus conventional ratio ventilation during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula: A randomized clinical trial. Paediatr Anaesth 2024; 34:332-339. [PMID: 38189583 DOI: 10.1111/pan.14836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Maintaining oxygenation during neonatal open repair of esophageal atresia/tracheoesophageal fistula is difficult. Inverse ratio ventilation can be used during one lung ventilation to improve the oxygenation and lung mechanics. OBJECTIVE The aim of this study was to describe the impact of two different ventilatory strategies (inverse ratio ventilation vs. conventional ratio ventilation) during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula on the incidence of oxygen desaturation episodes. METHODS We enrolled 40 term neonates undergoing open right thoracotomy for esophageal atresia/tracheoesophageal fistula repair and randomly assigned into two groups based on inspiratory to expiratory ratio of mechanical ventilation parameters (2:1 in inverse ratio ventilation "IRV" and 1:2 in conventional ratio ventilation "CRV"). The incidence of desaturation episodes that required stopping the procedure and reinflation of the lung were recorded as the primary outcome while hemodynamic parameters, incidence of complications, and length of surgical procedure were recorded as the secondary outcomes. RESULTS There was a trend toward a reduction in the incidence of severe desaturations (requiring stopping of surgery) with the use of inverse ratio ventilation (15% in IRV vs. 35% in CRV, RR [95% CI] 0.429 [0.129-1.426]). Incidence of all desaturations (including those requiring only an increase in ventilatory support or inspired oxygen saturation) was also reduced (40% in IRV vs. 75% in CRV, RR [95% CI] 0.533 [0.295-0.965]). This in turn affected the length of surgical procedure being significantly shorter in inverse ratio ventilation group (mean difference -16.3, 95% CI -31.64 to -0.958). The intraoperative fraction of inspired oxygen required to maintain adequate oxygen saturation was significantly lower in the inverse ratio ventilation group than in the conventional ratio ventilation group (mean difference -0.22, 95% CI -0.33 to -0.098), with no significant difference in hemodynamic stability or complications apart from higher blood loss in inverse ratio group. CONCLUSION There may be a role for inverse ratio ventilation with appropriate positive end-expiratory pressure to reduce the incidence of hypoxemia during open repair of esophageal atresia/tracheoesophageal fistula in neonates, further studies are required to establish the safety and efficacy of this technique.
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Affiliation(s)
- Azza M Youssef
- Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Hala S El-Ozairy
- Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ahmed M El-Hennawy
- Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Akram M Amer
- Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
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Sayed NH, Elaziz MSA, Elkholy AS, Taeimah MO. Effect of inverse ratio ventilation on hemodynamics and respiratory mechanics in obese patients undergoing laparoscopic sleeve gastrectomy. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2021. [PMCID: PMC8042839 DOI: 10.1186/s42077-021-00152-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Obesity has become a global epidemic problem affecting every system and is associated with many consequences including coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, obstructive sleep apnea, and socioeconomic and psychosocial impairment. Laparoscopic sleeve gastrectomy is one of the best and most commonly done operations for weight loss. Elevated peak airway pressure and hypoxemia are common problems that anesthesiologists face during laparoscopic surgeries with conventional volume-controlled ventilation. This study aimed at the use of the prolonged I:E ratio as an alternative strategy to improve gas exchange and the respiratory mechanics of obese patients undergoing laparoscopic sleeve gastrectomy. Results The study was a prospective randomized controlled trial and was performed between April 2019 and March 2020. After the approval of the departmental ethical committee and the informed written consent had been taken from the patients, fifty-two obese patients undergoing laparoscopic sleeve gastrectomy were enrolled in this study. After endotracheal intubation, the patients were randomly divided into the IRV group (n=26) and the VCV group (n=26). Respiratory parameters were adjusted as tidal volume (Vt) 8mL/kg ideal body weight, respiratory rate 12 breaths/min, positive-end expiratory pressure (PEEP) 0, fractional inspired oxygen (FiO2) 0.6, and I:E ratio 1:2 for the VCV group and 2:1 for the IRV group; hemodynamics and respiratory mechanics were monitored and recorded after intubation (0 min), before pneumoperitoneum (10 mins), and after pneumoperitoneum (20 mins), 30, 40, 50, and 60 mins. IRV significantly improves the respiratory mechanics during pneumoperitoneum in the form of decreasing the peak pressure (Ppeak) and plateau pressure (Pplat) and improving the dynamic compliance, but the mean pressure (Pmean) was increased; it also increased the partial pressure of oxygen (arterial PO2) significantly. No statistical significance was found regarding the demographic data or the hemodynamics. Conclusion IRV is superior to conventional VCV in morbidly obese patients undergoing laparoscopic sleeve gastrectomy as it improves respiratory mechanics and oxygenation.
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Adabala V, Tripathi M, Gupta P, Parameswaran P, Challa R, Kumar A. Effects of intraoperative inverse ratio ventilation on postoperative pulmonary function tests in the patients undergoing laparoscopic cholecystectomy: A prospective single blind study. Indian J Anaesth 2021; 65:S86-S91. [PMID: 34188261 PMCID: PMC8191195 DOI: 10.4103/ija.ija_1453_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/21/2020] [Accepted: 03/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Induction of general anaesthesia is associated with development of atelectasis in the lungs, which may further lead to postoperative pulmonary complications. Inverse ratio ventilation (IRV) has shown to improve oxygenation and minimise further lung injury in patients with acute respiratory distress syndrome. We evaluated the safety and effectiveness of IRV on intraoperative respiratory mechanics and postoperative pulmonary function tests (PFTs). Methods: In a prospective, controlled study, 128 consecutive patients with normal preoperative PFTs who underwent elective laparoscopic cholecystectomy were randomised into IRV and conventional ventilation groups. Initially, all patients were ventilated with settings of tidal volume 8 mL/kg, respiratory rate 12/min, inspiratory/expiratory ratio (I: E) = 1:2, positive end expiratory pressure = 0. Once the pneumoperitoneum was created, the conventional group patients were continued to be ventilated with same settings. However, in the IRV group, I: E ratio was changed to 2:1. Peak pressure (Ppeak), Plateau pressure (Pplat) and lung compliance were measured. Haemodynamic parameters and arterial blood gas values were also measured. PFTs were repeated in postoperative period. Statistical tool included Chi-square test. Results: There was no significant difference in PFTs in patients who underwent IRV as compared to conventional ventilation [forced vital capacity (FVC) 2.52 ± 0.13 versus 2.63 ± 0.16, P = 0.28]. The Ppeak (cmH2O) and Pplat (cmH2O) were statistically lower in IRV patients [Ppeak 21.4 ± 3.4 versus 22.4 ± 4.2, P = 0.003] [Pplat 18.7 ± 2.4 versus 19.9.4 ± 3.2, P = 0.008]. There was no significant difference in lung compliance and oxygenation intraoperatively. Conclusion: Intraoperative IRV led to reduced airway pressures; however, it did not prevent deterioration of PFTs in postoperative period.
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Affiliation(s)
- Vijay Adabala
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Mukesh Tripathi
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Prabakaran Parameswaran
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Revanth Challa
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Ajit Kumar
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
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Wang Y, Huang W, He M, Peng L, Cai M, Yuan C, Hu Z, Li K. [Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1008-1012. [PMID: 32895160 DOI: 10.12122/j.issn.1673-4254.2020.07.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Weijian Huang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Mudan He
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Lingli Peng
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Mingyang Cai
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Chao Yuan
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Kunwei Li
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
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Xu L, Shen J, Yan M. The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery. J Anesth 2017; 31:651-656. [DOI: 10.1007/s00540-017-2369-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/22/2017] [Indexed: 01/20/2023]
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Zhang W. Reply to: Respiratory acidosis in obese gynecologic patients undergoing laparoscopic surgery independently of the type of ventilation. ACTA ACUST UNITED AC 2016; 54:134. [PMID: 28024716 DOI: 10.1016/j.aat.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/23/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Wangping Zhang
- Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China.
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A randomized comparison of the Ambu AuraGain versus the LMA supreme in patients undergoing gynaecologic laparoscopic surgery. J Clin Monit Comput 2016; 31:1255-1262. [DOI: 10.1007/s10877-016-9963-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
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Zhang W, Zhu S. The effects of inverse ratio ventilation on cardiopulmonary function and inflammatory cytokine of bronchoaveolar lavage in obese patients undergoing gynecological laparoscopy. ACTA ACUST UNITED AC 2016; 54:1-5. [DOI: 10.1016/j.aat.2015.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/20/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022]
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Beleña JM, Ochoa EJ, Núñez M, Gilsanz C, Vidal A. Role of laryngeal mask airway in laparoscopic cholecystectomy. World J Gastrointest Surg 2015; 7:319-325. [PMID: 26649155 PMCID: PMC4663386 DOI: 10.4240/wjgs.v7.i11.319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.
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Lee K, Oh YJ, Choi YS, Kim SH. Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study. J Clin Anesth 2015; 27:445-50. [PMID: 26263797 DOI: 10.1016/j.jclinane.2015.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/05/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To investigate the effects of a 1:1 inspiratory-to-expiratory (I:E) ventilation ratio on oxygenation and respiratory mechanics during one-lung ventilation (OLV) in patients with low diffusion capacity of lung for carbon monoxide (DLCO). DESIGN Prospective, randomized, crossover study. SETTING Operating room, university hospital. PATIENTS Twenty-six patients with a preoperative DLCO less than 80% who were scheduled for lung lobectomy requiring OLV under general anesthesia. INTERVENTIONS In the first group (n = 13), OLV was begun with a 1:1 I:E ratio, which was switched to a 1:2 I:E ratio after 30 minutes. In the second group (n = 13), the modes of ventilation were performed in the opposite order. Pressure-controlled ventilation with 5 cm H2O of positive end-expiratory pressure and a tidal volume of 5 to 8 mL/kg was applied during OLV. MEASUREMENTS Arterial and central venous blood gas analyses were recorded and used to calculate intrapulmonary shunt fraction and physiologic dead space. These measurements were taken at 4 time points: 10 minutes after two-lung ventilation in the lateral decubitus position, 30 minutes after initiation of OLV, 30 minutes after switching the I:E ratio, and 10 minutes after two-lung ventilation was resumed. MAIN RESULTS There was no difference in arterial oxygen tension during OLV between the 2 groups (P = .429). Arterial carbon dioxide tension and peak airway pressure were lower in the 1:1 group than in the 1:2 group (P = .003; P = .008). Physiologic dead space was also decreased in the 1:1 I:E ratio group (P = .003). Mean airway pressure and dynamic compliance were higher in the 1:1 group (P = .003; P = .007). CONCLUSIONS Pressure-controlled ventilation with a 1:1 I:E ventilation ratio did not improve oxygenation in patients with low DLCO during OLV compared with a 1:2 I:E ventilation ratio. However, it did provide benefits in terms of respiratory mechanics and increased the efficiency of alveolar ventilation during OLV.
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Affiliation(s)
- Kyuho Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kim MS, Kim NY, Lee KY, Choi YD, Hong JH, Bai SJ. The impact of two different inspiratory to expiratory ratios (1:1 and 1:2) on respiratory mechanics and oxygenation during volume-controlled ventilation in robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Can J Anaesth 2015; 62:979-87. [DOI: 10.1007/s12630-015-0383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/01/2015] [Indexed: 11/30/2022] Open
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Mousa WF. Equal ratio ventilation (1:1) improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study. Saudi J Anaesth 2013; 7:9-13. [PMID: 23717224 PMCID: PMC3657935 DOI: 10.4103/1658-354x.109559] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Hypoxaemia and high peak airway pressure (Ppeak) are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory) ratio ventilation (1:1) improves arterial oxygenation with parallel decrease in the Ppeak values. Methods: Thirty patients with a body mass index ≥40 kg/m2 scheduled for laparoscopic bariatric surgery were randomized, after creation of pneumoperitoneum, to receive I:E ratio either 1:1 (group 1, 15 patients) or 1:2 (group 2, 15 patients). After a stabilization period of 30 min, patients were crossed over to the other studied I:E ratio. Ppeak, mean airway pressure (Pmean), dynamic compliance (Cdyn), arterial blood gases and hemodynamic data were collected at the end of each stabilization period. Results: Ventilation with I: E ratio of 1:1 significantly increased partial pressure of O2 in the arterial blood (PaO2), Pmean and Cdyn with concomitant significant decrease in Ppeak compared to ventilation with I: E ratio of 1:2. There were no statistical differences between the two groups regarding the mean arterial pressure, heart rate, respiratory rate, end tidal CO2 or partial pressure of CO2 in the arterial blood. Conclusion: Equal ratio ventilation (1:1) is an effective technique in increase PaO2 during laparoscopic bariatric surgery. It increases Pmean and Cdyn while decreasing Ppeak without adverse respiratory or hemodynamic effects.
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Affiliation(s)
- Wesam Farid Mousa
- Department of Anesthesia and Surgical ICU, College of Medicine, University of Dammam, Al Khobar, Saudi Arabia
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