Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients

Details

Serval ID
serval:BIB_DE8F8625621A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients
Journal
Anesth Analg
Author(s)
Coussa  M., Proietti  S., Schnyder  P., Frascarolo  P., Suter  M., Spahn  D. R., Magnusson  L.
ISSN
0003-2999
Publication state
Published
Issued date
05/2004
Volume
98
Number
5
Pages
1491-5, table of contents
Notes
0003-2999
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: May --- Old uritopublisher value: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15105237
Abstract
Atelectasis caused by general anesthesia is increased in morbidly obese patients. We have shown that application of positive end-expiratory pressure (PEEP) during the induction of anesthesia prevents atelectasis formation in nonobese patients. We therefore studied the efficacy of PEEP in morbidly obese patients to prevent atelectasis. Twenty-three adult morbidly obese patients (body mass index >35 kg/m(2)) were randomly assigned to one of two groups. In the PEEP group, patients breathed 100% oxygen (5 min) with a continuous positive airway pressure of 10 cm H(2)O and, after the induction, mechanical ventilation via a face mask with a PEEP of 10 cm H(2)O. In the control group, the same induction was applied but without continuous positive airway pressure or PEEP. Atelectasis, determined by computed tomography, and blood gas analysis were measured twice: before the induction and directly after intubation. After endotracheal intubation, patients of the control group showed an increase in the amount of atelectasis, which was much larger than in the PEEP group (10.4% +/- 4.8% in control group versus 1.7% +/- 1.3% in PEEP group; P < 0.001). After intubation with a fraction of inspired oxygen of 1.0, PaO(2) was significantly higher in the PEEP group compared with the control group (457 +/- 130 mm Hg versus 315 +/- 100 mm Hg, respectively; P = 0.035) We conclude that in morbidly obese patients, atelectasis formation is largely prevented by PEEP applied during the anesthetic induction and is associated with a better oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during induction of general anesthesia in morbidly obese patients prevents atelectasis formation and improves oxygenation. Therefore, this technique should be considered for anesthesia induction in morbidly obese patients.
Keywords
Adult Aged Anesthesia, General/*adverse effects Atelectasis/*prevention & control/radiography Blood Gas Analysis Body Mass Index Female Human Male Middle Aged Obesity, Morbid/*complications Positive-Pressure Respiration Tomography, X-Ray Computed
Pubmed
Web of science
Create date
11/04/2008 12:19
Last modification date
20/08/2019 16:03
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