Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass

N. T. Nguyen, J. T. Anderson, M. Budd, N. W. Fleming, H. S. Ho, J. Jahr, C. M. Stevens, Bruce Wolfe

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: Hypercarbia and elevated intraabdominal pressure resulting from carbon dioxide (CO2) pneumoperitoneum can adversely affect respiratory mechanics. This study examined the changes in mechanical ventilation, CO2 homeostasis, and pulmonary gas exchange in morbidly obese patients undergoing a laparoscopic or open gastric bypass (GBP) procedure. Methods: In this study, 58 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly allocated to laparoscopic (n = 31) or open (n = 27) GBP. Minute ventilation was adjusted to maintain a low normal arterial partial pressure of CO2 (PaCO2), low normal end-tidal partial pressure of CO2 (ETCO2), and low airway pressure. Respiratory compliance, ETCO2, peak inspiratory pressure (PIP), total exhaled CO2 per minute (VCO2), and pulse oximetry (SO2) were measured at 30-min intervals. The acid-base balance was determined by arterial blood gas analysis at 1-h intervals. The pulmonary gas exchange was evaluated by calculation of the alveolar dead space-to-tidal volume ratio (VDalv/VT) and alveolar-arterial oxygen gradient (PAO2-PaO2). Results: The two groups were similar in age, gender, and BMI. As compared with open GBP, laparoscopic GBP resulted in higher ETCO2, PIP, and VCO2, and a lower respiratory compliance. Arterial blood gas analysis demonstrated higher PaCO2 and lower pH during laparoscopic GBP than during open GBP (p <0.05). The VDalv/VT ratio and PAO 2-PaO2 gradient did not change significantly during laparoscopic GBP. Intraoperative oxygen desaturation (SO2 <90%) did not develop in any of the patients in either group. Conclusions: Laparoscopic GBP alters intraoperative pulmonary mechanics and acid-base balance but does not significantly affect pulmonary oxygen exchange. Changes in pulmonary mechanics are well tolerated in morbidly obese patients when proper ventilator adjustments are maintained.

Original languageEnglish (US)
Pages (from-to)64-71
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

Fingerprint

Pulmonary Gas Exchange
Pneumoperitoneum
Gastric Bypass
Mechanics
Partial Pressure
Pressure
Blood Gas Analysis
Acid-Base Equilibrium
Oxygen
Lung
Compliance
Body Mass Index
Respiratory Mechanics
Oximetry
Hypercapnia
Tidal Volume
Mechanical Ventilators
Artificial Respiration
Carbon Dioxide
Ventilation

Keywords

  • Gastric bypass
  • Laparoscopy
  • Morbid obesity
  • Respiratory mechanics

ASJC Scopus subject areas

  • Surgery

Cite this

Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. / Nguyen, N. T.; Anderson, J. T.; Budd, M.; Fleming, N. W.; Ho, H. S.; Jahr, J.; Stevens, C. M.; Wolfe, Bruce.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 18, No. 1, 01.2004, p. 64-71.

Research output: Contribution to journalArticle

Nguyen, N. T. ; Anderson, J. T. ; Budd, M. ; Fleming, N. W. ; Ho, H. S. ; Jahr, J. ; Stevens, C. M. ; Wolfe, Bruce. / Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. In: Surgical Endoscopy and Other Interventional Techniques. 2004 ; Vol. 18, No. 1. pp. 64-71.
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T1 - Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass

AU - Nguyen, N. T.

AU - Anderson, J. T.

AU - Budd, M.

AU - Fleming, N. W.

AU - Ho, H. S.

AU - Jahr, J.

AU - Stevens, C. M.

AU - Wolfe, Bruce

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N2 - Background: Hypercarbia and elevated intraabdominal pressure resulting from carbon dioxide (CO2) pneumoperitoneum can adversely affect respiratory mechanics. This study examined the changes in mechanical ventilation, CO2 homeostasis, and pulmonary gas exchange in morbidly obese patients undergoing a laparoscopic or open gastric bypass (GBP) procedure. Methods: In this study, 58 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly allocated to laparoscopic (n = 31) or open (n = 27) GBP. Minute ventilation was adjusted to maintain a low normal arterial partial pressure of CO2 (PaCO2), low normal end-tidal partial pressure of CO2 (ETCO2), and low airway pressure. Respiratory compliance, ETCO2, peak inspiratory pressure (PIP), total exhaled CO2 per minute (VCO2), and pulse oximetry (SO2) were measured at 30-min intervals. The acid-base balance was determined by arterial blood gas analysis at 1-h intervals. The pulmonary gas exchange was evaluated by calculation of the alveolar dead space-to-tidal volume ratio (VDalv/VT) and alveolar-arterial oxygen gradient (PAO2-PaO2). Results: The two groups were similar in age, gender, and BMI. As compared with open GBP, laparoscopic GBP resulted in higher ETCO2, PIP, and VCO2, and a lower respiratory compliance. Arterial blood gas analysis demonstrated higher PaCO2 and lower pH during laparoscopic GBP than during open GBP (p <0.05). The VDalv/VT ratio and PAO 2-PaO2 gradient did not change significantly during laparoscopic GBP. Intraoperative oxygen desaturation (SO2 <90%) did not develop in any of the patients in either group. Conclusions: Laparoscopic GBP alters intraoperative pulmonary mechanics and acid-base balance but does not significantly affect pulmonary oxygen exchange. Changes in pulmonary mechanics are well tolerated in morbidly obese patients when proper ventilator adjustments are maintained.

AB - Background: Hypercarbia and elevated intraabdominal pressure resulting from carbon dioxide (CO2) pneumoperitoneum can adversely affect respiratory mechanics. This study examined the changes in mechanical ventilation, CO2 homeostasis, and pulmonary gas exchange in morbidly obese patients undergoing a laparoscopic or open gastric bypass (GBP) procedure. Methods: In this study, 58 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly allocated to laparoscopic (n = 31) or open (n = 27) GBP. Minute ventilation was adjusted to maintain a low normal arterial partial pressure of CO2 (PaCO2), low normal end-tidal partial pressure of CO2 (ETCO2), and low airway pressure. Respiratory compliance, ETCO2, peak inspiratory pressure (PIP), total exhaled CO2 per minute (VCO2), and pulse oximetry (SO2) were measured at 30-min intervals. The acid-base balance was determined by arterial blood gas analysis at 1-h intervals. The pulmonary gas exchange was evaluated by calculation of the alveolar dead space-to-tidal volume ratio (VDalv/VT) and alveolar-arterial oxygen gradient (PAO2-PaO2). Results: The two groups were similar in age, gender, and BMI. As compared with open GBP, laparoscopic GBP resulted in higher ETCO2, PIP, and VCO2, and a lower respiratory compliance. Arterial blood gas analysis demonstrated higher PaCO2 and lower pH during laparoscopic GBP than during open GBP (p <0.05). The VDalv/VT ratio and PAO 2-PaO2 gradient did not change significantly during laparoscopic GBP. Intraoperative oxygen desaturation (SO2 <90%) did not develop in any of the patients in either group. Conclusions: Laparoscopic GBP alters intraoperative pulmonary mechanics and acid-base balance but does not significantly affect pulmonary oxygen exchange. Changes in pulmonary mechanics are well tolerated in morbidly obese patients when proper ventilator adjustments are maintained.

KW - Gastric bypass

KW - Laparoscopy

KW - Morbid obesity

KW - Respiratory mechanics

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