Atelectasis in obese patients undergoing laparoscopic bariatric surgery are not increased upon discharge from Post Anesthesia Care Unit

Frontiers in Medicine

Medicine

Markus M. Luedi¹  Markus Huber¹  Lea Ruscher¹  Andreas Vogt¹  Martina Kämpfer¹  Thomas Riva¹  Alexander Fuchs²  Matthias Braun³  Thomas Riedel⁴ 

[1] Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland;Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland;Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy;Department of Anaesthesiology, Lindenhof Hospital, Bern, Switzerland;Division of Paediatric Intensive Care Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;

关键词: adipositas;    general anesthesia;    laparoscopic surgery;    bariatric (weight loss) surgery;    mechanical ventilation;   

DOI  :  10.3389/fmed.2023.1233609

 received in 2023-06-05, accepted in 2023-07-31,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundObese patients frequently develop pulmonary atelectasis upon general anesthesia. The risk is increased during laparoscopic surgery. This prospective, observational single-center study evaluated atelectasis dynamics using Electric Impedance Tomography (EIT) in patients undergoing laparoscopic bariatric surgery.MethodsWe included adult patients with ASA physical status I–IV and a BMI of ≥40. Exclusion criteria were known severe pulmonary hypertension, home oxygen therapy, heart failure, and recent pulmonary infections. The primary outcome was the proportion of poorly ventilated lung regions (low tidal variation areas) and the global inhomogeneity (GI) index assessed by EIT before discharge from the Post Anesthesia Care Unit compared to these same measures prior to initiation of anesthesia.ResultsThe median (IQR) proportion of low tidal variation areas at the different analysis points were T1 10.8% [3.6–15.1%] and T5 10.3% [2.6–18.9%], and the mean difference was −0.7% (95% CI: −5.8% −4.5%), i.e., lower than the predefined non-inferiority margin of 5% (p = 0.022). There were no changes at the four additional time points compared to T1 or postoperative pulmonary complications during the 14 days following the procedure.ConclusionWe found that obese patients undergoing laparoscopic bariatric surgery do not leave the Post Anesthesia Care Unit with increased low tidal variation areas compared to the preoperative period.

【 授权许可】

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Copyright © 2023 Braun, Ruscher, Fuchs, Kämpfer, Huber, Luedi, Riva, Vogt and Riedel.