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ANESTHETIC PHARMACOLOGY

Alveolar Recruitment and Arterial Desflurane Concentration During Bariatric Surgery

Juraj Sprung, MD, PhD^*, Francis X. Whalen, MD^*, Thomas Comfere, MD^*, Zeljko J. Bosnjak, PhD, Zeljko Bajzer, PhD, Ognjen Gajic, MD^||, Michael G. Sarr, MD, Darrell R. Schroeder, MS^¶, Lavonne M. Liedl, RT^*, Chetan P. Offord, RT, and David O. Warner, MD^*

From the *Department of Anesthesiology, Department of Surgery, Biomathematics Resource and Department of Biochemistry and Molecular Biology, ||Division of Pulmonary and Critical Care Medicine, ¶Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, and Anesthesia Research Medical College of Wisconsin, Milwaukee, Wisconsin.

Address correspondence and reprint requests to Juraj Sprung, MD, PhD, Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Address e-mail to Sprung.juraj{at}mayo.edu.

BACKGROUND: We investigated whether reversal of intraoperative atelectasis with the lung recruitment maneuver (RM) affects desflurane arterial concentrations during bariatric surgery.

METHODS: After anesthetic induction and maintenance with propofol, patients were randomized to receive alveolar RM at intervals (RM group) or not (controls). Desflurane 6% was initiated, and rate of increase of alveolar desflurane concentration (ratio of end-expiratory to inspiratory concentrations, F_A/F_I) and desflurane blood concentrations were measured in both groups. Blood and end-tidal desflurane concentrations were also measured after the discontinuation of anesthesia.

RESULTS: The RM group had higher intraoperative Pao₂/Fio₂ compared with the control group (both, P < 0.001). During induction, the rate of increase in blood desflurane concentrations was rapid in both groups. At comparable mechanical ventilation settings, median times to achieve 0.5 mM (approximately 3%) were 2.1 and 1.59 min (P = 0.09) in the control and RM group, respectively. The times to achieve 0.7 mM (approximately 4.2%) desflurane were 15.9 and 9.3 min in the control and RM group, respectively (P = 0.08). Desflurane blood concentrations tended to be higher during the first 30 min after induction in the RM group (P = 0.066). During maintenance or emergence, the blood desflurane concentrations were not different between control and RM groups. Consequently, the time to eye opening did not differ between groups.

CONCLUSION: Although the RM during bariatric surgery represents an effective method for improving intraoperative oxygenation, it does not significantly affect the desflurane blood concentrations during anesthesia or its elimination during emergence.

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