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GENERAL ARTICLES

Positive End-Expiratory Pressure During Induction of General Anesthesia Increases Duration of Nonhypoxic Apnea in Morbidly Obese Patients

Sylvain Gander, MD^*, Philippe Frascarolo, PhD^*, Michel Suter, MD, Donat R. Spahn, MD^*, and Lennart Magnusson, MD, PhD^*

Departments of *Anesthesiology and Surgery, University Hospital, Lausanne, Switzerland

Address correspondence and reprint requests to Lennart Magnusson, MD, PhD, Department of Anesthesiology, University Hospital, CHUV BH-10, CH-1011 Lausanne, Switzerland. Address e-mail to lennart.magnusson{at}chuv.hospvd.ch.

Positive end-expiratory pressure (PEEP) applied during induction of anesthesia prevents atelectasis formation and increases the duration of nonhypoxic apnea in nonobese patients. PEEP also prevents atelectasis formation in morbidly obese patients. Because morbidly obese patients have difficult airway management more often and because arterial desaturation develops rapidly, we studied the clinical benefit of PEEP applied during anesthesia induction. Thirty morbidly obese patients were randomly allocated to one of two groups. In the PEEP group, patients breathed 100% O₂ through a continuous positive airway pressure device (10 cm H₂O) for 5 min. After induction of anesthesia, they were mechanically ventilated with PEEP (10 cm H₂O) for another 5 min until tracheal intubation. In the control group, the sequence was the same but without any continuous positive airway pressure or PEEP. We measured apnea duration until Spo₂ reached 90% and we performed arterial blood gases analyses just before apnea and at 92% Spo₂. Nonhypoxic apnea duration was longer in the PEEP group compared with the control group (188 ± 46 versus 127 ± 43 s; P = 0.002). Pao₂ was higher before apnea in the PEEP group (P = 0.038). Application of positive airway pressure during induction of general anesthesia in morbidly obese patients increases nonhypoxic apnea duration by 50%.

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