Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000200006
Brazilian Journal of Anesthesiology
Scientific Article

Impacto da manobra de recrutamento alveolar no pós-operatório de cirurgia bariátrica videolaparoscópica

Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery

Paula Patelli Juliani Remístico; Sebastião Araújo; Luciana Castilho de Figueiredo; Esperidião Elias Aquim; Larissa Mottim Gomes; Morgana Lima Sombrio; Sabrina Donatti Ferreira Ambiel

http://dx.doi.org/10.1590/S0034-70942011000200006 Braz J Anesthesiol, vol.61, n2, p.169-176, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: Complicações pulmonares em cirurgias bariátricas são frequentes, e, por isso, manobras de recrutamento alveolar (MRA) têm sido utilizadas para preveni-las ou reduzi-las no pós-operatório (PO) imediato. O objetivo do estudo foi avaliar o impacto da MRA executada no intraoperatório de pacientes submetidos à cirurgia bariátrica por videolaparoscopia na incidência de complicações pulmonares no pós-operatório. MÉTODO: Ensaio clínico aleatório com 30 pacientes alocados em Grupo Controle (GC) e Grupo Experimental (GE), sendo analisadas variáveis espirométricas, ventilatórias, hemodinâmicas e radiográficas. A MRA foi realizada no GE com pressão positiva expiratória final de 30 cmH2O e pressão de platô inspiratória de 45 cmH2O por 2 minutos após a desinsuflação do pneumoperitôneo. RESULTADOS: Observaram-se queda significativa nos valores espirométricos (p < 0,001) e maior incidência de complicações pulmonares na radiografia torácica (p = 0,02) no GC, bem como melhora significativa da escala de BORG dispneia (p < 0,001) no GE. CONCLUSÕES: Concluiu-se que a MRA é uma técnica segura e eficaz quando utilizada para a prevenção de complicações pulmonares em pacientes submetidos à cirurgia bariátrica, resultando em achados espirométricos e radiológicos mais favoráveis no Grupo Experimental em relação ao Grupo Controle no PO.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications. METHODS: Randomized clinical trial with 30 patients divided into control group (CG) and experimental group (EG), with analysis of spirometric, ventilatory, hemodynamic, and radiographic variables. ARM was performed in EG with positive end expiratory pressure of 30 cmH2O and inspiratory plateau pressure of 45 cmH2O for 2 minutes after pneumoperitoneum deflation. RESULTS: We observed a significant decrease in spirometric values (p < 0.001) and higher incidence of pulmonary complications on chest radiograph (p = 0.02) in CG, as well as significant improvement in dyspnoea Borg scale (p < 0.001) in EG. CONCLUSIONS: We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.

Keywords

Positive Pressure Respiration, Postoperative Complications, Pulmonary Atelectasis, Laparoscopy, Bariatric Surgery

References

National Institutes of Health Consensus Development Conference Statement: Gastrointestinal surgery for severy obesity. Am J Clin Nutr. 1992;55(2^ssuppl):615s-619s.

Nguyen NT, Goldman C, Rosenquist CJ. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279-291.

Ogunnaike BO, Jones SB, Jones DB. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95:1793-1805.

Sharp JT, Henry JP, Sweany SK. Effects of mass loading the respiratory system in man. J Appl Physiol. 1964;19:959-966.

Hedenstierna G, Tokics L, Strandberg A. Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand. 1986;30:183-191.

Damia G, Mascheroni D, Croci M. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth. 1988;60:574-578.

Buckley FP. Anaesthesia for the morbidly obese patient. Can J Anaesth. 1994;41:R94-100.

Lundquist H, Hedenstierna G, Strandberg A. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol. 1995;36:626-632.

Braga AFA, Silva ACM, Cremonesi E. Obesidade mórbida: considerações clínicas e anestésicas. Rev Bras Anestesiol. 1999;49:201-212.

Eichenberger AS, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788-1792.

Lorentz MN, Albergaria VF, Lima FAS. Anestesia para obesidade mórbida. Rev Bras Anestesiol. 2007;57:199-213.

Visick WD, Fairley HB, Hickey RF. The effects of tidal volume and end-expiratory pressure on pulmonary gas exchange during anesthesia. Anesthesiology. 1973;39:285-290.

Pelosi P, Ravagnan I, Giurati G. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91:1221-1231.

Sprung J, Whalley DG, Falcone T. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg. 2002;94:1345-1350.

Whalen FX, Gajic O, Thompson GB. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg. 2006;102:298-305.

Kanner RE, Schenker MB, Muñoz A. Spirometry in children: Methodology for obtaining optimal results for clinical and epidemiological studies. Am Rev Respir Dis. 1983;127:720-724.

Crapo RO. Pulmonary-function testing. N Engl J Med. 1994;331:25-30.

Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med. 1994;149:s9-20.

Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144:1202-1218.

Paisani DM, Chiavegato LD, Faresin SM. Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia. J Bras Pneumol. 2005;31:125-132.

Cardoso Filho GM, Diogo Filho A, Ribeiro GCC. Provas de função pulmonar no pré e pós-operatório de redução gástrica por celiotomia ou por videolaparoscopia. Rev Col Bras Cir. 2008;35:382-386.

Auler JOC, Miyoshi E, Fernandes CR. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg. 2002;94:741-748.

Putensen-Himmer G, Putensen C, Lammer H. Comparison of postoperative respiratory function after laparoscopy or open laparotomy for cholecystectomy. Anesthesiology. 1992;77:675-680.

Schauer PR, Luna J, Ghiatas A. Pulmonary function after laparoscopic cholecystectomy. Surgery. 1993;114:389-399.

Curley FJ. Dyspnea. Diagnosis and Treatment of Symptoms of the Respiratory Tract. 1997:55-115.

Dyspnea: mechanisms, assessment, and management: a consensus statement. Am J Respir Crit Care Med. 1999;159:321-340.

Coussa M, Proietti S, Schnyder P. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98:1491-1495.

Singh PK, Agarwal A, Gaur A. Increasing tidal volumes and PEEP is an effective method of alveolar recruitment. Can J Anaesth. 2002;49.

Villagra A, Ochagavia A, Vatua S. Recruitment maneuvers during lung protective ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002:165-170.

Tusman G, Bohm SH, Vasquez de Anda GF. Alveolar recruitment strategy improves arterial oxigenation during general anaesthesia. Br J Anaesth. 1999;82:8-13.

Dyhr T, Nygard E, Laursen N. Both lung recruitment maneuver and PEEP are needed to increase oxygenation and volume after cardiac surgery. Acta Anaesthesiol Scand. 2004;48:187-197.

Rothen HU, Sporre B, Engberg G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth. 1993;71:788-795.

Rothen HU, Sporre B, Engberg G. Atelectasis and pulmonary shunting during induction of general anaesthesia: can they be avoided?. Acta Anaesthesiol Scand. 1996;40:524-529.

Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth. 2003;91:61-72.

Souza AP, Buschpigel M, Mathias LAST. Análise dos efeitos da manobra de recrutamento alveolar na oxigenação sanguínea durante procedimento bariátrico. Rev Bras Anestesiol. 2009;59:177-186.

Sprung J, Whalen FX, Comfere T. Alveolar recruitment and arterial desflurane concentration during bariatric surgery. Anesth Analg. 2009;108:120-127.

Cadi P, Guenoun T, Journois D. Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation. Br J Anaesth. ;100:709-716.

Grasso S, Mascia L, Del Turco M. Effects of recruitment maneuver in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology. 2002;96:795-802.

Amato MBP, Barbas CSV, Medeiros DM. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338:347-354.

Lindner KH, Lotz P, Ahnefeld FW. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest. 1987;92:66-70.

Stock MC, Downs JB, Corkran ML. Pulmonary function before and after prolonged continuous positive airway pressure by mask. Crit Care Med. 1984;12:973-974.

Pinilla JC, Oleniuk FH, Tan L. Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med. 1990;18:836-840.

Huerta S, DeShields S, Shpiner R. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after roux-en-y gastric bypass. J Gastrointest Surg. 2002;6:354-358.

Gaszynski T, Tokarz A, Piotrowski D. Boussignac CPAP in the postoperative period in morbidly obese patients. Obes Surg. 2007;17:452-456.

Constantin JM, Futier E, Cherprenet AL. A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study. Crit Care. 2010;14.

Dumont L, Mattys M, Mardirosoff C. Hemodynamic changes during laparoscopic gastroplasty in morbidly obese patients. Obes Surg. 1997;7:326-331.

Bardoczky GI, Yernault J-C, Houben J-J. Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg. 1995;81:385-388.

Demiroluk S, Salihoglu Z, Zengin K. The effects of pneumoperitoneum on respiratory mechanics during bariatric surgery. Obes Surg. 2001;12:376-379.

Valenza F, Vagginelli F, Tiby A. Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. Anesthesiology. 2007;107:725-732.

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