Alveolar recruitment and arterial desflurane concentration during bariatric surgery.
BACKGROUND
We investigated whether reversal of intraoperative atelectasis with the lung recruitment maneuver (RM) affects desflurane arterial concentrations during bariatric surgery.


METHODS
After anesthetic induction and maintenance with propofol, patients were randomized to receive alveolar RM at intervals (RM group) or not (controls). Desflurane 6% was initiated, and rate of increase of alveolar desflurane concentration (ratio of end-expiratory to inspiratory concentrations, F(A)/F(I)) and desflurane blood concentrations were measured in both groups. Blood and end-tidal desflurane concentrations were also measured after the discontinuation of anesthesia.


RESULTS
The RM group had higher intraoperative Pao(2)/Fio(2) compared with the control group (both, P < 0.001). During induction, the rate of increase in blood desflurane concentrations was rapid in both groups. At comparable mechanical ventilation settings, median times to achieve 0.5 mM (approximately 3%) were 2.1 and 1.59 min (P = 0.09) in the control and RM group, respectively. The times to achieve 0.7 mM (approximately 4.2%) desflurane were 15.9 and 9.3 min in the control and RM group, respectively (P = 0.08). Desflurane blood concentrations tended to be higher during the first 30 min after induction in the RM group (P = 0.066). During maintenance or emergence, the blood desflurane concentrations were not different between control and RM groups. Consequently, the time to eye opening did not differ between groups.


CONCLUSIONS
Although the RM during bariatric surgery represents an effective method for improving intraoperative oxygenation, it does not significantly affect the desflurane blood concentrations during anesthesia or its elimination during emergence.
Sprung
Juraj
J
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. Sprung.juraj@mayo.ed
Whalen
Francis X
FX
Comfere
Thomas
T
Bosnjak
Zeljko J
ZJ
Bajzer
Zeljko
Z
Gajic
Ognjen
O
Sarr
Michael G
MG
Schroeder
Darrell R
DR
Liedl
Lavonne M
LM
Offord
Chetan P
CP
Warner
David O
DO
D000328:Adult; D018685:Anesthetics, Inhalation / Q000097:blood* / Q000493:pharmacokinetics; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D050110:Bariatric Surgery; D000077335:Desflurane; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration; D015742:Propofol / Q000009:adverse effects*; D011650:Pulmonary Alveoli / Q000187:drug effects* / Q000378:metabolism; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012119:Respiration / Q000187:drug effects
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000077335:Desflurane; D007530:Isoflurane; D010100:Oxygen; D015742:Propofol