sábado, 16 de abril de 2011

Efecto de la apertura abdominal sobre los mecanismos respiratorios durante anestesia general para cirugía bariátrica abierta en pacientes obesos mórbidos


Efecto de la apertura abdominal sobre los mecanismos respiratorios
durante anestesia general para cirugía bariátrica abierta en pacientes
 obesos mórbidos

 The effects of abdominal opening on respiratory mechanics during general anaesthesia for open bariatric 
surgery in morbidly obese patients.
Gaszyński TM.
Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Poland.
 tomasz.gaszynski@umed.lodz.pl
Anestezjol Intens Ter. 2010 Oct-Dec;42(4):172-4.
Abstract
BACKGROUND: Morbid obesity BMI 40 kg mL-2 is associated with several changes in anatomy
 and physiology of the respiratory system. Respiratory work is increased whereas compliance of the chest
 wall and lungs is decreased. Increased intra-abdominal pressure compresses the diaphragm and reduces its
 movability. Abdominal opening should influence respiratory mechanics. METHODS: Forty-seven morbidly obese
 patients (BMI 49.54 ± 7.21 kg m-2) scheduled for elective bariatric surgery
 (open Roux-en-Y-Gastric Bypass - RYGB) were included in the study and divided into 3 groups:
 40< BMI <50, 50< BMI <60 and BMI >60. Measurements were performed during general anaesthesia
 at two time points: before (T1) and after abdominal opening (T2). All patients were ventilated using the volume
 control mode.
RESULTS: Preoperative spirometry revealed significantly decreased FEV 1% in the BMI >60 group.
 The conditions of mechanical ventilation during general anaesthesia deteriorated with an increasing BMI. 
After abdominal opening,the mechanical ventilation conditions improved: increased lung compliance and
 decreased airway pressures. The difference was statistically significant in the entire population studied.
 After dividing the population into groups, however, the difference was no longer significant in patients with 
BMI >60. The most significant difference in peak and plateau pressures after abdominal opening was observed
 in patients with BMI <50. CONCLUSION: Abdominal opening improves the conditions of mechanical ventilation
 in morbidly obese patients; when BMI is over 60 kg m-2, this improvement may not be relevant.


Atentamente
Anestesiología y Medicina del Dolor

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