Impact of Overweight and Pneumoperitoneum on Hemodynamics and Oxygenation during Prolonged Laparoscopic Surgery |
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Authors: | Dirk Meininger MD PhD Bernhard Zwissler MD PhD Christian Byhahn MD PhD Michael Probst MD Klaus Westphal MD PhD Dorothee H Bremerich MD PhD |
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Institution: | (1) Department of Anesthesiology, Intensive Care Medicine and Pain Control, J. W. Goethe-University Hospital, Theodor-Stern-Kai 7, Frankfurt, D-60590, Germany;(2) Department of Urology and Pediatric Urology, J. W. Goethe-University Hospital, Theodor-Stern-Kai 7, Frankfurt, D-60590, Germany;(3) Department of Anesthesiology and Intensive Care Medicine, Katharina-Kasper- Kliniken, Richard - Wagner - Strasse 14, Frankfurt, D-60590, Germany |
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Abstract: | Background Anesthesia adversely affects respiratory function and hemodynamics in obese patients. Although many studies have been performed
in morbidly obese patients, data are limited concerning overweight patients BMI 25–29.9 kg m−2]. The aim of this study was to evaluate the effects of prolonged pneumoperitoneum in Trendelenburg position on hemodynamics
and gas exchange in normal and overweight patients.
Methods We studied 15 overweight and 15 non-obese BMI 18.5–24.9 kg m−2] patients who underwent totally endoscopic robot-assisted radical prostatectomy under general anesthesia with an inspired
oxygen fraction of 0.5. A standardized anesthetic regimen was used, and patients were examined at standard times: after induction
of anesthesia and Trendelenburg posture, every 30 minutes after establishing pneumoperitoneum, and after the release of the
pneumoperitoneum with the patient still in Trendelenburg position.
Results After induction of anesthesia and Trendelenburg positioning arterial oxygen pressure PaO2] and alveolar-arterial difference in oxygen tension AaDO2] differed significantly between both groups with lower PaO2 235 ± 27 versus 164 ± 51 mmHg] and higher AaDO2 149 ± 48 versus 76 ± 28 mmHg] values in overweight patients. During pneumoperitoneum, PaO2 transient increased above baseline values in overweight patients, whereas AaDO2 decreased. Hemodynamic parameters HR, MAP, and CVP] did not differ significantly between groups.
Conclusions Arterial oxygenation and AaDO2 are significantly impaired in overweight patients under general anesthesia in Trendelenburg posture. In overweight patients
pneumoperitoneum transient reduced the impairment of arterial oxygenation and lead to a decrease in AaDO2. Hemodynamic parameters were not affected by body weight. |
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