title: Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery.
abstract: Robotic assisted surgery (RAS) represents a great challenge for anesthesiology due to the increased intraabdomial pressures required for surgical optimal approach. The changes in lung physiology are difficult to predict and require fast decision making in order to prevent altered gas exchange. The aim of this study was to document the combined effect of patient physical status, medical history and intraoperative position during RAS on lung physiology and to determine perioperative risk factors for hypercapnia. We prospectively analyzed 62 patients who underwent elective RAS. Age, co-morbidities and body mass index (BMI) were recorded before surgery. Ventilatory parameters and arterial blood gas analysis were determined before induction of anesthesia, after tracheal intubation and on an hourly basis until the end of surgery. In RAS, the induction of pneumoperitoneum was associated with a significant decrease in lung compliance from a mean of 42.5-26.7 ml cm H2O-1(p = 0.001) and an increase in plateau pressure from a mean of 16.1 mmHg to a mean of 23.6 mmHg (p = 0.001). Obesity, demonstrated by a BMI over 30, significantly correlates with a decrease in lung compliance after induction of anesthesia (p = 0.001). A significant higher increase in arterial CO2tension was registered in patients undergoing RAS in steep Trendelenburg position (p = 0.05), but no significant changes in end-tidal CO2were recorded. A higher arterial to end-tidal CO2tension gradient was observed in patients with a BMI > 30 (p < 0.001). In conclusion, patients' physical status, especially obesity, represents the main risk factor for decreased lung compliance during RAS and patient positioning in either Trendelenburg or steep Trendelenburg during surgery has limited effects on respiratory physiology.
authors.affiliation: Department of Anesthesiology and Critical Care III, Fundeni Clinical Institute, 258 Fundeni Street, 2nd District, Bucharest, 022328, Romania. danatomescu@gmail.com.|"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. danatomescu@gmail.com.
authors.forename: Dana Rodica
authors.initials: DR
authors.lastname: Tomescu
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Popescu
authors.affiliation: "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Simona Olimpia
authors.initials: SO
authors.lastname: Dima
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Bacalbașa
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.|Department of Anesthesiology and Critical Care, "C.C. Iliescu" Institute for Cardiovascular Disease, Bucharest, Romania.
authors.forename: Șerban
authors.initials: Ș
authors.lastname: Bubenek-Turconi
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000627:therapeutic use; D001784:Blood Gas Analysis; D015992:Body Mass Index; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology*; D007432:Intraoperative Period; D008170:Lung Compliance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009765:Obesity / Q000503:physiopathology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures
chemical_list: D000777:Anesthetics
keywords: Hypercapnia; Lung compliance; Mechanical ventilation; Respiratory physiology; Robotic assisted surgery
references.citation: Chirurgia (Bucur). 2007 May-Jun;102(3):263-70
references.pmid: 17687853
references.citation: J Clin Anesth. 2001 Aug;13(5):361-5
references.pmid: 11498317
references.citation: Anesth Analg. 1998 Sep;87(3):654-60
references.pmid: 9728848
references.citation: Anesthesiology. 2005 Feb;102(2):293-9
references.pmid: 15681942
references.citation: Minerva Anestesiol. 1997 Jun;63(6):177-82
references.pmid: 9374078
references.citation: Korean J Anesthesiol. 2010 Nov;59(5):329-34
references.pmid: 21179295
references.citation: World J Surg. 2008 Jul;32(7):1400-5
references.pmid: 18224479
references.citation: N Engl J Med. 2010 Aug 19;363(8):701-4
references.pmid: 20818872
references.citation: J Obstet Gynaecol Res. 2012 Jan;38(1):1-8
references.pmid: 22136216
references.citation: Acta Anaesthesiol Scand. 2007 Jul;51(6):687-92
references.pmid: 17465975
references.citation: Int J Med Robot. 2007 Sep;3(3):281-6
references.pmid: 17924452
references.citation: Surg Endosc. 2012 Jan;26(1):1-11
references.pmid: 21858568
references.citation: Br J Anaesth. 2010 Apr;104(4):433-9
references.pmid: 20167583
references.citation: Minerva Anestesiol. 2012 May;78(5):596-604
references.pmid: 22415437
references.citation: Br J Anaesth. 2004 Feb;92(2):202-7
references.pmid: 14722169
references.citation: Int J Med Robot. 2007 Dec;3(4):312-5
references.pmid: 18200624
references.citation: Korean J Anesthesiol. 2012 Sep;63(3):209-15
references.pmid: 23060976
references.citation: Br J Anaesth. 2005 Jan;94(1):121-7
references.pmid: 15486001
references.citation: Eur Urol. 2012 Sep;62(3):431-52
references.pmid: 22749853
references.citation: Anesth Analg. 2002 May;94(5):1345-50
references.pmid: 11973218