Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study.
BACKGROUND
Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass.


METHODS
After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg(-1) of IBW) were randomly ventilated with either 10 cm H₂O PEEP or with 10 cm H₂O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea-hypopnoea index (AHI) were recorded during the first postoperative night.


RESULTS
Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups (P=0.35). FVC, FEV1, mean [Formula: see text], percentage of time spent with [Formula: see text] below 90%, and AHI did not differ significantly between the groups.


CONCLUSIONS
This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery.


BACKGROUND
EudraCT 2011-000999-33.
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
A A
AA
Defresne
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
G A
GA
Hans
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
P J
PJ
Goffin
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
S P
SP
Bindelle
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
P J
PJ
Amabili
Department of Abdominal Surgery and Transplantation, CHU of Liege, University of Liege, Belgium.
A M
AM
DeRoover
Department of Sleep Wake Disorders, CHU of Liege, University of Liege, Domaine du Sart Tilman, B-4000 Liege, Belgium.
R
R
Poirrier
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium.
J F
JF
Brichant
Department of Anaesthesiology and Intensive Care Medicine, CHU of Liege, University of Liege, Belgium jean.joris@chu.ulg.ac.be.
J L
JL
Joris
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000032:analysis; D005260:Female; D005652:Functional Residual Capacity / Q000502:physiology; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control*; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D013147:Spirometry / Q000379:methods / Q000706:statistics & numerical data; D013990:Tidal Volume / Q000502:physiology; D055815:Young Adult
D002245:Carbon Dioxide
anaesthesia; functional residual capacity; obesity; pulmonary ventilation