Abstract
BackgroundExisting data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied.Methods This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blood gases were measured at predetermined time intervals intraoperatively. Categorical variables were analyzed using Fisher’s exact test, while numerical variables within and between groups were compared using repeated measures general linear model.ResultsThe incidence of bronchospasm was significantly higher in obese compared to non obese patients (P = 0.027). Peak airway pressures and blood gases differed significantly when comparing non obese patients versus obese patients without bronchospasm versus obese patients with bronchospasm. Hypoventilation resulting in gradual increase of arterial PaCO2 was noted in all groups during surgery.ConclusionThe incidence of bronchospasm is higher in obese patients compared to non obese patients undergoing elective laparoscopic surgery. Airway pressures and blood gas values in obese patients are somewhere between values in non obese patients and values in patients with bronchospasm, thereby implying that obesity is associated with a state where bronchial smooth muscles are not fully relaxed. Consideration of increased airway reactivity in obese patients undergoing laparoscopic surgery is important for improved patient care and uneventful anesthetic course.
Highlights
Existing data suggest that obesity correlates with airway hyper-reactivity
This argument has been questioned by experimental data showing increased airway responsiveness resulting in bronchospasm in obese compared with lean mice, even when the mechanical load from excessive adipose tissue is eliminated by opening the chest wall and the lungs are exposed to ozone (Shore et al 2003)
Our results showed high incidence of bronchospasm (6 of 50, 12 %) in obese patients, which is significantly higher compared to the incidence in nonobese patietns (0 of 50, 0 %, P = 0.027)
Summary
Existing data suggest that obesity correlates with airway hyper-reactivity. the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. Tassoudis et al SpringerPlus (2016) 5:435 static and elastic forces which are enhanced in obesity, due to small lung volumes and reduced functional residual capacity (FRC) (Yap et al 1995; Damia et al 1988; Pelosi et al 1997; Ding et al 1987; Fredberg 2000; Gump et al 2001; Sampson and Grassino 1983). This argument has been questioned by experimental data showing increased airway responsiveness resulting in bronchospasm in obese compared with lean mice, even when the mechanical load from excessive adipose tissue is eliminated by opening the chest wall and the lungs are exposed to ozone (Shore et al 2003). The third theory implicates an inflammatory microenvironment that promotes airway narrowing in response to adipocyte-derived factors causing inflammation and bronchial irritation (Rajala and Scherer 2003; Hotamisligil 2003; Nawrocki and Scherer 2004; Chen et al 2003)
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