OPEN LUNG STRATEGY IN OBESE PATIENTS DURING LAPAROSCOPIC CHOLECYSTECTOMY

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BackgroundThis article describes a clinical study of the open lungs strategy of ventilation in patients with I–II degree of obesity during laparoscopic cholecystectomy.Our main goals were to establish the effect of increased intra-abdominal pressure on the general thoraco-pulmonary compliance in normal and overweight groups of patients and in patients with I–II degree of obesity; to investigate safe apnea time and the effectiveness of short-term, non-invasive, respiratory CPAP – therapy as a variant of pre-oxygenation before general anesthesia; to establish the effectiveness of the use of increased PEEP; to establish the efficiency and safety of alveolar recruitment and to determine the recruitability of patient’s lungs.Materials and methods. 60 patients undergoing laparoscopic cholecystectomy were selected and divided into four groups. In two study groups, non-invasive respiratory CPAP therapy was used before surgery, and increased positive end-expiratory pressure and alveolar recruitment maneuvers were used during general anesthesia. We recorded the indicators of general thoraco-pulmonary compliance at the appropriate control points. In addition, we studied safe apnea time as an indicator of the effectiveness of preoperative CPAP therapy.Results. Lung compliance was 37.5% lower in patients with obesity of I–II degree than in patients with normal body weight. Sleep apnea time was shorter by an average of 68 seconds (23%) in obese patients compared with normal weight patients. Lung compliance decreased by 36–38% in all groups of patients after increasing of intra-abdominal pressure to 15 mmHg. The use of respiratory CPAP therapy increased lung compliance in patients with obesity by an average of 17%. The use of non-invasive respiratory CPAP therapy prolongs sleep apnea time by an average of 44 seconds.Conclusions. The use of open lung strategy improved respiratory rates in study groups. The obtained data testify in favor of wider application of possibilities of respiratory therapy during general anesthesia.