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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 Nov; 107(5):725-32.A

Abstract

BACKGROUND

The authors studied the effects of the beach chair (BC) position, 10 cm H2O positive end-expiratory pressure (PEEP), and pneumoperitoneum on respiratory function in morbidly obese patients undergoing laparoscopic gastric banding.

METHODS

The authors studied 20 patients (body mass index 42 +/- 5 kg/m2) during the supine and BC positions, before and after pneumoperitoneum was instituted (13.6 +/- 1.2 mmHg). PEEP was applied during each combination of position and pneumoperitoneum. The authors measured elastance (E,rs) of the respiratory system, end-expiratory lung volume (helium technique), and arterial oxygen tension. Pressure-volume curves were also taken (occlusion technique). Patients were paralyzed during total intravenous anesthesia. Tidal volume (10.5 +/- 1 ml/kg ideal body weight) and respiratory rate (11 +/- 1 breaths/min) were kept constant throughout.

RESULTS

In the supine position, respiratory function was abnormal: E,rs was 21.71 +/- 5.26 cm H2O/l, and end-expiratory lung volume was 0.46 +/- 0.1 l. Both the BC position and PEEP improved E,rs (P < 0.01). End-expiratory lung volume almost doubled (0.83 +/- 0.3 and 0.85 +/- 0.3 l, BC and PEEP, respectively; P < 0.01 vs. supine zero end-expiratory pressure), with no evidence of lung recruitment (0.04 +/- 0.1 l in the supine and 0.07 +/- 0.2 in the BC position). PEEP was associated with higher airway pressures than the BC position (22.1 +/- 2.01 vs. 13.8 +/- 1.8 cm H2O; P < 0.01). Pneumoperitoneum further worsened E,rs (31.59 +/- 6.73; P < 0.01) and end-expiratory lung volume (0.35 +/- 0.1 l; P < 0.01). Changes of lung volume correlated with changes of oxygenation (linear regression, R2 = 0.524, P < 0.001) so that during pneumoperitoneum, only the combination of the BC position and PEEP improved oxygenation.

CONCLUSIONS

The BC position and PEEP counteracted the major derangements of respiratory function produced by anesthesia and paralysis. During pneumoperitoneum, only the combination of the two maneuvers improved oxygenation.

Authors+Show Affiliations

Istituto di Anestesia e Rianimazione, Fondazione Ospedale Maggiore, Mangiagalli e Regina Elena-IRCCS, Milan, Italy. franco.valenza@unimi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18073547

Citation

Valenza, Franco, et al. "Effects of the Beach Chair Position, Positive End-expiratory Pressure, and Pneumoperitoneum On Respiratory Function in Morbidly Obese Patients During Anesthesia and Paralysis." Anesthesiology, vol. 107, no. 5, 2007, pp. 725-32.
Valenza F, Vagginelli F, Tiby A, et al. 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(5):725-32.
Valenza, F., Vagginelli, F., Tiby, A., Francesconi, S., Ronzoni, G., Guglielmi, M., Zappa, M., Lattuada, E., & Gattinoni, L. (2007). Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. Anesthesiology, 107(5), 725-32.
Valenza F, et al. 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(5):725-32. PubMed PMID: 18073547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. AU - Valenza,Franco, AU - Vagginelli,Federica, AU - Tiby,Alberto, AU - Francesconi,Silvia, AU - Ronzoni,Giulio, AU - Guglielmi,Massimiliano, AU - Zappa,Marco, AU - Lattuada,Ezio, AU - Gattinoni,Luciano, PY - 2007/12/13/pubmed PY - 2008/1/16/medline PY - 2007/12/13/entrez SP - 725 EP - 32 JF - Anesthesiology JO - Anesthesiology VL - 107 IS - 5 N2 - BACKGROUND: The authors studied the effects of the beach chair (BC) position, 10 cm H2O positive end-expiratory pressure (PEEP), and pneumoperitoneum on respiratory function in morbidly obese patients undergoing laparoscopic gastric banding. METHODS: The authors studied 20 patients (body mass index 42 +/- 5 kg/m2) during the supine and BC positions, before and after pneumoperitoneum was instituted (13.6 +/- 1.2 mmHg). PEEP was applied during each combination of position and pneumoperitoneum. The authors measured elastance (E,rs) of the respiratory system, end-expiratory lung volume (helium technique), and arterial oxygen tension. Pressure-volume curves were also taken (occlusion technique). Patients were paralyzed during total intravenous anesthesia. Tidal volume (10.5 +/- 1 ml/kg ideal body weight) and respiratory rate (11 +/- 1 breaths/min) were kept constant throughout. RESULTS: In the supine position, respiratory function was abnormal: E,rs was 21.71 +/- 5.26 cm H2O/l, and end-expiratory lung volume was 0.46 +/- 0.1 l. Both the BC position and PEEP improved E,rs (P < 0.01). End-expiratory lung volume almost doubled (0.83 +/- 0.3 and 0.85 +/- 0.3 l, BC and PEEP, respectively; P < 0.01 vs. supine zero end-expiratory pressure), with no evidence of lung recruitment (0.04 +/- 0.1 l in the supine and 0.07 +/- 0.2 in the BC position). PEEP was associated with higher airway pressures than the BC position (22.1 +/- 2.01 vs. 13.8 +/- 1.8 cm H2O; P < 0.01). Pneumoperitoneum further worsened E,rs (31.59 +/- 6.73; P < 0.01) and end-expiratory lung volume (0.35 +/- 0.1 l; P < 0.01). Changes of lung volume correlated with changes of oxygenation (linear regression, R2 = 0.524, P < 0.001) so that during pneumoperitoneum, only the combination of the BC position and PEEP improved oxygenation. CONCLUSIONS: The BC position and PEEP counteracted the major derangements of respiratory function produced by anesthesia and paralysis. During pneumoperitoneum, only the combination of the two maneuvers improved oxygenation. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/18073547/Effects_of_the_beach_chair_position_positive_end_expiratory_pressure_and_pneumoperitoneum_on_respiratory_function_in_morbidly_obese_patients_during_anesthesia_and_paralysis_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/01.anes.0000287026.61782.a6 DB - PRIME DP - Unbound Medicine ER -