Impact of Grade I obesity on respiratory mechanics during video laparoscopic surgery: prospective longitudinal study

Introduction and objectives: The association pneumoperitoneum and obesity in video laparoscopy can contribute to pulmonary complications, but has not been well defined in specific groups of obese individuals. We assessed the effects of pneumoperitoneum in respiratory mechanics in Grade I obese compared to non-obese. Methods: Prospective study including 20 patients submitted to video laparoscopic cholecystectomy, normal spirometry, divided into non-obese (BMI <= 25 kg.m(-2)) and obese (BMI > 30 kg.mg(-2)), excluding Grade II and III obese. We measured pulmonary ventilation mechanics data before pneumoperitoneum (baseline), and five, fifteen and thirty minutes after peritoneal insufflation, and fifteen minutes after disinflation (final). Results: Mean BMI of non-obese was 22.72 +/- 1.43 kg.m(-2) and of the obese 31.78 +/- 1.09 kg.m(-2), p < 0.01. Duration of anesthesia and of peritoneal insufflation was similar between groups. Baseline pulmonary compliance (Crs) of the obese (38.3 +/- 8.3 mL.cm H2O-1) was lower than of the non-obese (47.4 +/- 5.7 mL.cm H2O-1), p = 0.01. After insufflation, Crs decreased in both groups and remained even lower in the obese at all moments assessed (GLM p < 0.01). Respiratory system peak pressure and plateau pressure were higher in the obese, albeit variations were similar at moments analyzed (GLM p > 0.05). The same occurred with elastic pressure, higher in the obese at all times (GLM p = 0.04), and resistive pressure showed differences in variations between groups during pneumoperitoneum (GLM p = 0,05). Conclusions: Grade 1 obese presented more changes in pulmonary mechanics than the non-obese during video laparoscopies and the fact requires mechanical ventilation-related care. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.

Palavras-chave

Respiratory mechanics, Obese, Video laparoscopy, Ventilation, Compliance

URI

https://observatorio.fm.usp.br/handle/OPI/37613

Referências

Akoumianaki E, 2014, AM J RESP CRIT CARE, V189, P520, DOI 10.1164/rccm.201312-2193CI
Auler Junior José Otávio Costa, 2003, Rev. Bras. Anestesiol., V53, P227, DOI 10.1590/S0034-70942003000200010
BAYDUR A, 1982, AM REV RESPIR DIS, V126, P788
Bluth T, 2017, TRIALS, V18, DOI 10.1186/s13063-017-1929-0
Cunningham AJ, 2001, CLIN ANESTH, P1051
ERIKSEN J, 1978, ACTA ANAESTH SCAND, V22, P241, DOI 10.1111/j.1399-6576.1978.tb01298.x
FAHY BG, 1995, ANESTH ANALG, V81, P744, DOI 10.1097/00000539-199510000-00015
Flegal KM, 2016, JAMA-J AM MED ASSOC, V315, P2284, DOI 10.1001/jama.2016.6458
Hodgson LE, 2015, J THORAC DIS, V7, P943, DOI 10.3978/j.issn.2072-1439.2015.03.08
LUCE JM, 1980, CHEST, V78, P626, DOI 10.1378/chest.78.4.626
Pelosi P, 1998, ANESTH ANALG, V87, P654, DOI 10.1097/00000539-199809000-00031
Pelosi P, 1999, ANESTHESIOLOGY, V91, P1221, DOI 10.1097/00000542-199911000-00011
Pelosi P, 2010, BEST PRACT RES-CLIN, V24, P211, DOI 10.1016/j.bpa.2010.02.001
Pereira SM, 2018, ANESTHESIOLOGY, V129, P1070, DOI 10.1097/ALN.0000000000002435
Rizzotti L, 2002, RESP MED, V96, P268, DOI 10.1053/rmed.2001.1264
Sebastian JC, 2013, BEST PRACT RES CL EN, V27, P157, DOI 10.1016/j.beem.2013.04.014
TOBIN MJ, 1988, AM REV RESPIR DIS, V138, P1625, DOI 10.1164/ajrccm/138.6.1625
Valenza F, 2010, BEST PRACT RES-CLIN, V24, P227, DOI 10.1016/j.bpa.2010.02.002
WHO World Health Organization, 2016, OB OV

Coleções

Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - LIM/08

Carregar mais

Página do item completo