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GENERAL ARTICLES

Prevention of Atelectasis Formation During the Induction of General Anesthesia in Morbidly Obese Patients

Marta Coussa, MD^*, Stefania Proietti, MD, Pierre Schnyder, MD, Philippe Frascarolo, PhD^*, Michel Suter, MD PhD, Donat R. Spahn, MD^*, and Lennart Magnusson, MD PhD^*

Departments of *Anesthesiology, Diagnostic Radiology, and General 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

Atelectasis caused by general anesthesia is increased in morbidly obese patients. We have shown that application of positive end-expiratory pressure (PEEP) during the induction of anesthesia prevents atelectasis formation in nonobese patients. We therefore studied the efficacy of PEEP in morbidly obese patients to prevent atelectasis. Twenty-three adult morbidly obese patients (body mass index >35 kg/m²) were randomly assigned to one of two groups. In the PEEP group, patients breathed 100% oxygen (5 min) with a continuous positive airway pressure of 10 cm H₂O and, after the induction, mechanical ventilation via a face mask with a PEEP of 10 cm H₂O. In the control group, the same induction was applied but without continuous positive airway pressure or PEEP. Atelectasis, determined by computed tomography, and blood gas analysis were measured twice: before the induction and directly after intubation. After endotracheal intubation, patients of the control group showed an increase in the amount of atelectasis, which was much larger than in the PEEP group (10.4% ± 4.8% in control group versus 1.7% ± 1.3% in PEEP group; P < 0.001). After intubation with a fraction of inspired oxygen of 1.0, PaO₂ was significantly higher in the PEEP group compared with the control group (457 ± 130 mm Hg versus 315 ± 100 mm Hg, respectively; P = 0.035) We conclude that in morbidly obese patients, atelectasis formation is largely prevented by PEEP applied during the anesthetic induction and is associated with a better oxygenation.

IMPLICATIONS: Application of positive end-expiratory pressure during induction of general anesthesia in morbidly obese patients prevents atelectasis formation and improves oxygenation. Therefore, this technique should be considered for anesthesia induction in morbidly obese patients.

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