Body Habitus and Dynamic Surgical Conditions Independently Impair Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery A Cross-sectional Study

ConclusionsIncreasing body mass index induces significant alterations in lung mechanics during robotic laparoscopic surgery, but there is a wide range in the degree of impairment. Positive end-expiratory pressure settings may need individualization based on body mass index and surgical conditions.Editor ’s PerspectiveWhat We Already Know about This TopicPrior studies suggest that intraoperative use of standardized tidal volumes based on ideal body weight are beneficial. However, attempts to define optimal positive end-expiratory pressure levels remain elusive given varying effects of body habitus and dynamic surgical conditions (pneumoperitoneum and Trendelenberg positioning).Using esophageal manometry, the authors partitioned respiratory mechanical properties into lung and chest wall components in patients undergoing robotic laparoscopic surgery to assess the effects of obesity, pneumoperitoneum and Trendelenberg positioning on transpulmonary driving pressures and estimate optimal positive end-expiratory pressure for a given degree of obesity or surgical condition.What This Article Tells Us That Is NewObese patients demonstrated increased driving pressures and decreased mean end-expiratory transpulmonary pressures. Pneumoperitoneum and Trendelenberg position further accentuated these differences. The optimal positive end-expiratory pressure was greater than set positive end-expiratory pressure in most subjects at all stages, ranging from 0 to 36.6  cm H2O.Intraoperative ...

Source: Anesthesiology - July 9, 2020 Category: Anesthesiology Source Type: research