JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Sprung, J. Articles by Hammel, J. Search for Related Content PubMed PubMed Citation Articles by Sprung, J. Articles by Hammel, J.

---

GENERAL ARTICLES

The Impact of Morbid Obesity, Pneumoperitoneum, and Posture on Respiratory System Mechanics and Oxygenation During Laparoscopy

Juraj Sprung, MD PhD^*, David G. Whalley, MB ChB, Tommaso Falcone, MD, David O. Warner, MD^*, Rolf D. Hubmayr, MD, and Jeffrey Hammel, MS^||

*Department of Anesthesiology and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota; Department of Anesthesiology, Cleveland Clinic Florida, Naples, Florida; and Obstetrics and Gynecology and Minimally Invasive Surgery Section and || Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio

Address correspondence and reprint requests to Juraj Sprung, MD, PhD, Associate Professor of Anesthesiology, Mayo Medical School, Department of Anesthesiology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905. Address e-mail to Sprung.juraj{at}mayo.edu

We studied the effect of morbid obesity, 20 mm Hg pneumoperitoneum, and body posture (30° head down and 30° head up) on respiratory system mechanics, oxygenation, and ventilation during laparoscopy. We hypothesized that insufflation of the abdomen with CO₂ during laparoscopy would produce more impairment of respiratory system mechanics and gas exchange in the morbidly obese than in patients of normal weight. The static respiratory system compliance and inspiratory resistance were computed by using a Servo Screen pulmonary monitor. A continuous blood gas monitor was used to monitor real-time PaCO₂ and PaO₂, and the ETCO₂ was recorded by mass spectrometry. Static compliance was 30% lower and inspiratory resistance 68% higher in morbidly obese supine anesthetized patients compared with normal-weight patients. Whereas body posture (head down and head up) did not induce additional large alterations in respiratory mechanics, pneumoperitoneum caused a significant decrease in static respiratory system compliance and an increase in inspiratory resistance. These changes in the mechanics of breathing were not associated with changes in the alveolar-to-arterial oxygen tension difference, which was larger in morbidly obese patients. Before pneumoperitoneum, morbidly obese patients had a larger ventilatory requirement than the normal-weight patients to maintain normocapnia (6.3 ± 1.4 L/min versus 5.4 ± 1.9 L/min, respectively; P = 0.02). During pneumoperitoneum, morbidly obese, supine, anesthetized patients had less efficient ventilation: a 100-mL increase of tidal volume reduced PaCO₂ on average by 5.3 mm Hg in normal-weight patients and by 3.6 mm Hg in morbidly obese patients (P = 0.02). In conclusion, respiratory mechanics during laparoscopy are affected by obesity and pneumoperitoneum but vary little with body position. The PaO₂ was adversely affected only by increased body weight.

IMPLICATIONS: Morbid obesity significantly decreases respiratory system compliance and increases inspiratory resistance. Increased body weight, and not altered mechanics of breathing, was associated with worse PaO₂ during laparoscopy.

This article has been cited by other articles:

				P. Cadi, T. Guenoun, D. Journois, J.-M. Chevallier, J.-L. Diehl, and D. Safran Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation Br. J. Anaesth., May 1, 2008; 100(5): 709 - 716. [Abstract] [Full Text] [PDF]

				B. P. McGlinch, F. G. Que, J. L. Nelson, D. M. Wrobleski, J. E. Grant, and M. L. Collazo-Clavell Perioperative Care of Patients Undergoing Bariatric Surgery Mayo Clin. Proc., October 1, 2006; 81(10_Suppl): S25 - S33. [Abstract] [Full Text] [PDF]

				F. X. Whalen, O. Gajic, G. B. Thompson, M. L. Kendrick, F. L. Que, B. A. Williams, M. J. Joyner, R. D. Hubmayr, D. O. Warner, and J. Sprung The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric Surgery Anesth. Analg., January 1, 2006; 102(1): 298 - 305. [Abstract] [Full Text] [PDF]

				J. Sprung, D. G. Whalley, T. Falcone, W. Wilks, J. E. Navratil, and D. L. Bourke The Effects of Tidal Volume and Respiratory Rate on Oxygenation and Respiratory Mechanics During Laparoscopy in Morbidly Obese Patients Anesth. Analg., July 1, 2003; 97(1): 268 - 274. [Abstract] [Full Text] [PDF]

				B. O. Ogunnaike, S. B. Jones, D. B. Jones, D. Provost, and C. W. Whitten Anesthetic Considerations for Bariatric Surgery Anesth. Analg., December 1, 2002; 95(6): 1793 - 1805. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999