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The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

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Abstract

Background

We investigated the effect of prolonged inspiratory to expiratory (I/E) ratio ventilation on respiratory mechanics, gas exchange, and regional cerebral oxygen saturation (rSO2) in obese patients undergoing laparoscopic bariatric surgery in the reverse Trendelenburg position.

Methods

Twenty-eight adult patients scheduled for laparoscopic sleeve gastrectomy were enrolled in this prospective observational study. After anesthesia induction, pressure-controlled ventilation was conducted initially at a conventional I/E ratio of 1:2 and a positive end-expiratory pressure of 5 cmH2O. Twenty minutes after pneumoperitoneum, the I/E ratio was changed to 1:1 for 20 min and then to 2:1 for 20 min. Hemodynamic variables, end-tidal carbon dioxide tension, rSO2, arterial blood gas analysis results, and respiratory variables were recorded.

Results

No significant changes in hemodynamic values and rSO2 were observed during the study. Peak airway pressure was significantly lower, but mean airway pressure and dynamic compliance were significantly higher at I/E ratios of 1:1 and 2:1 than during conventional I/E ratio ventilation. Arterial oxygen tension (PaO2) value was significantly higher (p = 0.009), and alveolar-arterial oxygen tension gradient was lower (p = 0.015) at an I/E ratio of 2:1 than during conventional ratio ventilation.

Conclusions

The use of prolonged I/E ratio of 2:1 significantly improved respiratory mechanics and arterial oxygenation without causing hemodynamic derangements or cerebral desaturation during laparoscopic bariatric surgery in the reverse Trendelenburg position.

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Conflict of Interest

All authors declare no conflict of interest.

A Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

A Statement of Human and Animal Rights

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea

    Youn Yi Jo, Chun Kon Park, Young Jin Chang & Hyun Jeong Kwak

  2. Department of Anesthesiology and Pain Medicine, Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea

    Ji Young Kim

Authors
  1. Youn Yi Jo
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  2. Ji Young Kim
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  3. Chun Kon Park
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  4. Young Jin Chang
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  5. Hyun Jeong Kwak
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Corresponding author

Correspondence to Hyun Jeong Kwak.

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Jo, Y.Y., Kim, J.Y., Park, C.K. et al. The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery. OBES SURG 26, 339–344 (2016). https://doi.org/10.1007/s11695-015-1766-8

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  • DOI: https://doi.org/10.1007/s11695-015-1766-8

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