Bronchospasm in obese patients undergoing elective laparoscopic surgery under general anesthesia.
BACKGROUND
Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied.


METHODS
This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blood gases were measured at predetermined time intervals intraoperatively. Categorical variables were analyzed using Fisher's exact test, while numerical variables within and between groups were compared using repeated measures general linear model.


RESULTS
The incidence of bronchospasm was significantly higher in obese compared to non obese patients (P = 0.027). Peak airway pressures and blood gases differed significantly when comparing non obese patients versus obese patients without bronchospasm versus obese patients with bronchospasm. Hypoventilation resulting in gradual increase of arterial PaCO2 was noted in all groups during surgery.


CONCLUSIONS
The incidence of bronchospasm is higher in obese patients compared to non obese patients undergoing elective laparoscopic surgery. Airway pressures and blood gas values in obese patients are somewhere between values in non obese patients and values in patients with bronchospasm, thereby implying that obesity is associated with a state where bronchial smooth muscles are not fully relaxed. Consideration of increased airway reactivity in obese patients undergoing laparoscopic surgery is important for improved patient care and uneventful anesthetic course.
Department of Anesthesiology, University of Larissa, Larissa, Greece.
Vassilios
V
Tassoudis
Department of Anesthesiology, University of Larissa, Larissa, Greece.
Hronis
H
Ieropoulos
Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO USA.
Menelaos
M
Karanikolas
Department of Anesthesiology, University of Larissa, Larissa, Greece.
George
G
Vretzakis
Intensive Care Unit, University Hospital of Larissa, Larissa, Greece.
Aik
A
Bouzia
Department of Anesthesiology, University of Larissa, Larissa, Greece.
Elias
E
Mantoudis
Department of Anesthesiology, University of Larissa, Larissa, Greece.
Argyro
A
Petsiti
Airway; Bariatric surgery; Bronchospasm; Complications; Laparoscopic surgery; Obesity; Oxygenation