ANESTHESIA & ANALGESIA 2006, ISSUE 102, P. 298-305 DEPARTMENTS OF ANESTHESIOLOGY AND SURGERY, DIVISION OF PULMONARY AND CRITICAL CARE MEDICINE, AND DEPARTMENT OF HEALTH SCIENCES RESEARCH, MAYO CLINIC COLLEGE OF MEDICINE, MAYO CLINIC, ROCHESTER, MINNESOTA FRANCIS X. WHALEN, MD, OGNJEN GAJIC, MD, GEOFFREY B. THOMPSON, MD, MICHAEL L. KENDRICK, MD, FLORENCIA L. QUE, MD, BRENT A. WILLIAMS, MS, MICHAEL J. JOYNER, MD, ROLF D. HUBMAYR, MD, DAVID O. WARNER, MD, AND JURAJ SPRUNG, MD, PHD The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric Surgery
Transcript
ANESTHESIA & ANALGESIA 2006 , ISSUE 102 , P. 298-305
DEPARTMENTS OF ANESTHESIOLOGY AND SURGERY, DIVISION OF PULMONARY AND CRITICAL CARE
MEDICINE, AND DEPARTMENT OF HEALTH SCIENCES RESEARCH, MAYO CLINIC COLLEGE OF MEDICINE,
MAYO CLINIC, ROCHESTER, MINNESOTA
FRANCIS X . WHALEN, MD, OGNJEN GAJIC, MD, GEOFFREY B. THOMPSON, MD, MICHAEL L . KENDRICK, MD, FLORENCIA L . QUE, MD, BRENT A. WILLIAMS, MS,
MICHAEL J. JOYNER, MD, ROLF D. HUBMAYR, MD, DAVID O. WARNER, MD, AND JURAJ SPRUNG, MD, PHD
The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic
Bariatric Surgery
Anesthesia and Pulmonary Function
What is atelectasis?
3 Basic mechanisms of atelectasis:
- Compression
- Absorption
- Loss of surfactant
Atelectasis and Anesthesia
The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric
Surgery
METHODS
Prospective randomized study
ASA II-III, Ages 25-65, BMI > 40 kg/m2
No significant pre-op. pulmonary disease, active asthma, or home 0xygen therapy.
Parameters Measured
Anesthetic management
Monitoring parameters
Mechanical ventilation
Recruitment maneuver
Alveolar Recruitment Maneuver
Results of the Study
No significant differences in demographics, surgical times, opioids, IV fluids.
Pa02/Fi02 significantly higher in recruitment group.
Recruitment group and compliance.
No significant difference in Pa02/Fi02 after extubation.
A Closer Look: Pa02/Fi02 and Compliance
Hemodynamics
Discussion
Recruitment group experienced a higher Pa02 intra-operatively.
Higher PaC02 and lower Pa02 in recruitment group post-operatively.
