Cardiopulmonary effects of prolonged surgical abdominal retractors application during general anesthesia: a prospective observational comparative study
Mohamed A. Ghanem, Ahmed S. El-Hefnawy
Abstract
Introduction
Increasing abdominal pressures could affect pulmonary compliance and cardiac performance, a fact based on which the aim of the present study to detect the cardiopulmonary burden of multiple retractors application during supine versus lateral abdominal surgeries. We hypothesized that surgical ring multiple retractors application would affect the pulmonary and cardiac functions during both lateral and supine abdominal surgeries.
Methods
Prospective observational comparative study on forty surgical patients subdivided into two groups twenty each, comparing pulmonary compliance and cardiac performance before, during and after retractors application, group (S) supine position cystectomy surgery, and group (L) lateral position nephrectomy surgery under general anesthesia, Composite 1ry outcome; dynamic compliance C-dyn and cardiac index CI and Other outcome variables ICON cardio-meter were also recorded.
Results
C-dyn and C-stat were significantly decreased late during retractor application in lateral compared to supine surgery with significant decrease compared to basal values all over the surgical time. CI was significantly increased after retractor removal in both of the study groups compared to basal values. PAWP was significantly increased in -lateral compared to supine surgery -with significant increase compared to basal value all over the surgical time in both of the study groups. significant increase in DO2I compared to basal value during both supine and lateral positions.
Conclusion
Surgical retraction results in a short-lived significant decreases in lung compliance and cardiac output particularly during the lateral-kidney position than the supine position compliance.
Keywords
References
1. V. Mazo, S. Sabaté, J. Canet, et al. Prospective external validation of a predictive score for postoperative pulmonary complications Anesthesiology., 121 (2014), pp. 219-231
2. R. Johnson, A. Arozullah, L. Neumayer, et al. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study J Am Coll Surg., 204 (2007), pp. 1188-1198
3. E. Kim, Y. Kim, C. Kang, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD Int J Chron Obstruct Pulmon Dis., 11 (2016), pp. 1317-1326
4. M. Kim, J. Brady, G. Li Interaction effects of acute kidney injury, acute respiratory failure, and sepsis on 30-day postoperative mortality in patients undergoing high-risk intra-abdominal general surgical procedures Anesth Analg., 121 (2015), pp. 1536-1546
5. A. Sonny, S. Grabitz, F. Timm, et al. Impact of postoperative respiratory complications on discharge disposition, mortality, and re-admissions ASA Abstr. (2016), p. A5016
6. L. Gunnarsson, L. Tokics, H. Gustavsson, et al. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia Br J Anaesth., 66 (1991), pp. 423-432
7. M.F.V. Melo, M. Eikermann Protect the lungs during abdominal surgery it may change the postoperative outcome Anesthesiology., 118 (2013), pp. 1254-1257
8. B. Andrew, M. Lumb Chapter 2 - Elastic Forces and Lung Volumes Nunn’s Applied Respiratory Physiology (Eighth Edition) (2017), pp. 17-32
9. M. Morega, A. Dobre, M. Morega Electrical Cardiometry simulation for the assessment of circulatory parameters Proceedings of the Romanian Academy, Series A, 17 (2016), pp. 259-266
10. F. Obeid, A. Saba, J. Fath, et al. Increases in intra-abdominal pressure affect pulmonary compliance Arch Surg., 130 (1995), pp. 544-547 discussion 547-548
11. Z. Salihoğlu, S. Demiroluk, A. Demirkaya, et al. Effects of positioning and ventilation strategy on the parameters of respiratory mechanics and blood gases during video-assisted thoracoscopic esophagectomy Turkish J Thorac. Cardiovasc. Surg., 18 (2010), pp. 209-213
12. P. Thomas, J. Paratz, J. Lipman, et al. Lateral positioning of ventilated intensive care patients: a study of oxygenation, respiratory mechanics, hemodynamics, and adverse events Heart Lung., 36 (2007), pp. 277-286
13. M. Mezidi, C. Guérin Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients Ann Transl Med., 6 (2018), p. 384
14. Z. Riad, M. Mezidi, F. Subtil, et al. Short-term Effects of the Prone Positioning Manoeuver on Lung and Chest Wall Mechanics in ARDS Patients Am J Respir Crit Care Med., 197 (2018), pp. 1355-1358
15. M. Yokoyama, W. Ueda, M. Hirakawa Hemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anesthesia Br J Anaesth., 84 (2000), pp. 753-757
16. R. Nakayama, T. Mihara, Y. Miyamoto, et al. The association of hypotension with the insertion of an abdominal retractor during lower abdominal surgery in pediatric patients: a retrospective observational study Paediatr Anaesth., 25 (2015), pp. 824-828
Submitted date:
06/02/2020
Accepted date:
06/20/2021
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email