Abstract
ABSTRACT Purpose The aim of this study was to evaluate the effect of recruitment maneuvers (RMs) and positive end expiratory pressure (PEEP) on diaphragmatic function and atelectasis areas during pneumoperitoneum and the trendelenburg position in laparoscopic sleeve gastrectomy (LSG) patients. Methods This prospective double-blinded randomized clinical study was conducted on 69 obese patients undergoing LSG. Patients were randomly allocated to one of the three groups, Group I (control group) patients were mechanically ventilated without PEEP or RM, Group II received PEEP of 5 cmH2O, and Group III received 5 cmH2O PEEP, and intermittent four times RM consisting of maintaining airway pressure 40 cmH2O for 40 s. Primary outcome was diaphragmatic excursion (DE). Secondary outcomes were atelectasis area, Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 s (FEV1), Peak Inspiratory Pressure (PIP), and any complications. Results DE decreased in all investigated groups after anesthesia induction till the end of procedure compared to pre-induction values, and it was statistically significant lower in control group compared to the two interventional groups with no significant difference between PEEP and PEEP+RM groups. Atelectasis volume according to lung aeration score was significantly increased in control group compared to the other two groups, while there was no statistical significant difference in PEEP+RM compared to PEEP in all the times except before induction of anesthesia there was no significant difference among the three groups. Conclusion The application of RM and PEEP are helpful for preserving DE and improving lung aeration during laparoscopic sleeve gastrectomy.
Highlights
Bariatric surgery is the most effective treatment for morbid obesity and its secondary co-morbidities
This CO2 pneumoperitoneum together with the steep Trendelenburg position, which is maintained for long period in laparoscopic sleeve gastrectomy (LSG), results in cephalic displacement of the diaphragm leading to several respiratory changes as decreased functional residual capacity (FRC) and vital capacity (VC) [8,9], decrease pulmonary compliance, resulting in atelectasis formation in the dependent lung regions [10,11]
Sixty-nine obese patients undergoing elective LSG under general anesthesia were enrolled in this study
Summary
Bariatric surgery is the most effective treatment for morbid obesity and its secondary co-morbidities. Laparoscopic procedures are operated under general anesthesia that decreases functional residual capacity (FRC) and enhances atelectasis [5]. It is performed in conjunction with intraabdominal CO2 insufflations and subsequent increase in the intra-abdominal pressure [6,7]. This CO2 pneumoperitoneum together with the steep Trendelenburg position, which is maintained for long period in LSG, results in cephalic displacement of the diaphragm leading to several respiratory changes as decreased FRC and vital capacity (VC) [8,9], decrease pulmonary compliance, resulting in atelectasis formation in the dependent lung regions [10,11]. Obese patients are more prone to develop perioperative atelectasis and postoperative pulmonary complications that is almost twice the risk among healthy subjects [12,13]
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