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GENERAL ARTICLES

The Effects of the Reverse Trendelenburg Position on Respiratory Mechanics and Blood Gases in Morbidly Obese Patients During Bariatric Surgery

Departments of *Anesthesiology and Surgery, Catholic University of Sacred Heart Rome, Rome, Italy

Address correspondence and reprint requests to V. Perilli, MD, Department of Anesthesiology, Catholic University of Sacred Heart Rome, Largo A. Gemelli, 8, 00168 Roma, Italy.

Anesthesia adversely affects respiratory function, particularly in morbidly obese patients. Although many studies have been performed to determine the optimal ventilatory settings in these patients, this question has not been answered. The aim of this study was to evaluate the effect of reverse Trendelenburg position (RTP) on gas exchange and respiratory mechanics in 15 obese patients undergoing biliopancreatic diversion. A standardized anesthetic regimen was used and patients were examined at standard times: 1) after tracheal intubation, 2) after laparotomy, 3) after positioning of subcostal retractors, 4) with retractors in RTP. The measurements of respiratory mechanics were repeated for a wide range of tidal volumes by using the technique of rapid occlusion during constant flow inflation. We noted a wide alveolar-arterial oxygen difference [P(A-a)O₂] in all patients, particularly during Phase 3. When the patients were placed in RTP, P(A-a)O₂ showed a significant improvement and a return toward baseline values. As for mechanics, total respiratory system compliance was significantly higher in RTP than in the other phases. In conclusion, our data suggest that RTP is an appropriate intraoperative posture for obese subjects because it causes minimal arterial blood pressure changes and improves oxygenation.

Implications: The aim of the study was to assess whether the reverse Trendelenburg position could improve pulmonary gas exchange in obese patients undergoing abdominal surgical procedures. Our work may have a clinical value because few studies deal with this issue.

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