Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients

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Intermittent positive pressure ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvre during inhalation anaesthesia.

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Presentation transcript:

Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients W.A. Almarakbi, H.M. Fawzi, J.A. Alhashemi British Journal of Anaesthesia Volume 102, Issue 6, Pages 862-868 (June 2009) DOI: 10.1093/bja/aep084 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 1 A CONSORT flow chart showing the flow of patients through the trial. British Journal of Anaesthesia 2009 102, 862-868DOI: (10.1093/bja/aep084) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 2 Outline of the study protocol. P, Group PEEP; R, group single recruitment manoeuvre; RP, group single recruitment manoeuvre followed by PEEP; RRP, group repeated recruitment manoeuvre with PEEP; ZEEP, zero end-expiratory pressure; RM, recruitment manoeuvre; INT, tracheal intubation; Tn, n min after induction of pneumoperitoneum. British Journal of Anaesthesia 2009 102, 862-868DOI: (10.1093/bja/aep084) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 3 Intraoperative changes in respiratory compliance, arterial partial pressure of oxygen (Pao2), and arterial partial pressure of carbon dioxide (Paco2) during the observation period. Respiratory compliance and arterial blood gas trends between groups. INT, 5 min after intubation; Tn, n min after induction of pneumoperitoneum; P, Group PEEP; R, group single recruitment manoeuvre; RP, group single recruitment manoeuvre followed by PEEP; RRP, group repeated recruitment manoeuvre with PEEP. (a) After the recruitment manoeuvre, respiratory compliance improved most in Group RRP (*P<0.01, between the groups) followed by Group RP (§P<0.01, between the groups), but there was no improvement in Groups P and R. (b) Pao2 decreased in all groups 10 min after pneumoperitoneum induction and remained so in Groups P and R (P<0.01). Recruitment manoeuvre increased Pao2 in Groups RP and RRP (§P<0.01, between the groups); however, this improvement was sustained only in Group RRP (*P<0.01, between the groups). (c) Paco2 increased in all groups after pneumoperitoneum induction and it decreased after the recruitment manoeuvre. However, Paco2 increased again at T30 and continued to rise until T50 in Groups P, R, and RP (P<0.01, within the groups). British Journal of Anaesthesia 2009 102, 862-868DOI: (10.1093/bja/aep084) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 4 Postoperative changes in pulse-oximetry-measured oxygen saturation (Spo2) during the first hour of recovery. Oxygen saturation trends between groups in the post-anaesthesia care unit (PACU); PACUn, n min after PACU admission; P, Group PEEP; R, group single recruitment manoeuvre; RP, group single recruitment manoeuvre followed by PEEP; RRP, group repeated recruitment manoeuvre with PEEP. On admission to PACU, Group RRP had the highest oxygen saturation followed by Group RP, which persisted through the first hour of recovery when compared with the other groups (*P<0.01 and §P<0.01, between the groups, respectively). British Journal of Anaesthesia 2009 102, 862-868DOI: (10.1093/bja/aep084) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions