What Every Anaesthetist Needs to Know About Respiratory and Cardiovascular Dynamics in Patients with Obesity or Intra-abdominal Hypertension

Abstract

The incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) is still underappreciated by clinicians working in the emergency department (ED), operating room (OR) or intensive care unit (ICU), around the world. Of note, one in four patients will have signs and symptoms of IAH on admission, whilst one out of two will develop IAH within the first week of ICU stay. Moreover, 1 in 20 patients will develop overt ACS, a lethal syndrome with a mortality rate above 75% when left untreated. Still, every day, patients may be exposed to the risks of unrecognised pathological increases in intra-abdominal pressure (IAP). Every ED, OR and ICU physician should therefore understand the pathophysiological mechanisms that may impact end-organ function when IAP is increased. IAP measurement is a first step, followed by prevention and medical measurements to lower the IAP. Monitoring of the respiratory and cardiovascular function during anaesthesia and surgery is of great importance. This chapter will focus on the definitions, how to measure IAP, and how to deal with the respiratory and cardiovascular derangements listing some simple tips that can be used at the bedside.