The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study.

Abstract

Morbid obesity has a profound effect on respiratory mechanics and gas exchange. However, most studies were performed in morbidly obese patients before or after anesthesia. We tested the hypothesis that anesthesia and abdominal opening could modify the elastic and resistive properties of the respiratory system. Eleven morbidly obese and eight normal-weight patients scheduled for gastric binding and cancer treatment, respectively, under laparotomy were studied. Respiratory mechanics, partitioned into its lung and chest wall components, were investigated during surgery by means of the end-inspiratory inflation occlusion method and esophageal balloon at five time points. Static respiratory and lung compliance were markedly reduced in obese patients; on the contrary, static compliance of chest wall presented comparable values in both groups. Obese patients also presented higher resistances of the total respiratory system, lung and chest wall, as well as "additional" lung resistance. Mainly in obese patients, laparotomy provoked a significant increase in lung compliance and decrease in "additional" lung resistance 1 h after the peritoneum was opened, which returned to original values after the peritoneum had been closed (P < 0.005). In obese patients, low respiratory compliance and higher airway resistance were mainly determined by the lung component.