Skip to main content

Comparison of Volume-controlled and Pressure-controlled Ventilation during Laparoscopic Gastric Banding in Morbidly Obese Patients



There are no guidelines on ventilation modes in morbidly obese patients. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on gas exchange, respiratory mechanics, and cardiovascular responses in laparoscopic gastric banding procedures.


After Institutional Review Board approval, 24 adult consenting patients scheduled for laparoscopic gastric banding were studied. Anesthesia was standardized using remifentanil, propofol, rocuronium, and sevoflurane. All patients started with VCV with a tidal volume of 10 ml kg−1 ideal body weight, respiratory rate adjusted to obtain an end-tidal carbon dioxide of 35–40 mmHg, positive end-expiratory pressure of 5 cmH2O, an inspiratory pause of 10% and an inspiratory/expiratory ratio of 1:2. Fifteen minutes after pneumoperitoneum, the patients were randomly allocated to two groups. In Group VCV (n = 12), ventilation was with the same parameters. In Group PCV (n = 12), the airway pressure was set to provide a tidal volume of 10 ml kg−1 ideal body weight without exceeding 35 cm H2O. Respiratory rate was adjusted to keep an end-tidal carbon dioxide of 35–40 mmHg. Arterial blood samples were drawn after surgical positioning and 15 min after allocation. Analysis of variance (ANOVA) was used for statistical analysis.


With constant minute ventilation, VCV generates equal airway pressures and cardiovascular effects with a lower PaCO2 as compared to PCV (42.5 (5.2) mmHg versus 48.9 (4.3) mmHg, p < 0.01 ANOVA). Arterial oxygenation remained unchanged.


VCV and PCV appear to be an equally suited ventilatory technique for laparoscopic procedures in morbidly obese patients. Carbon dioxide elimination is more efficient when using VCV.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27:1167–77.

    Article  PubMed  CAS  Google Scholar 

  2. Mason EE. Surgery in the obese. Lancet. 2003;361:2001–2.

    Article  PubMed  Google Scholar 

  3. Pelosi P, Croci M, Ravagnan I, et al. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109:144–51.

    Article  PubMed  CAS  Google Scholar 

  4. Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20:248–54.

    PubMed  CAS  Google Scholar 

  5. Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91:1221–31.

    Article  PubMed  CAS  Google Scholar 

  6. Bardoczky GI, Yernault JC, Houben JJ, et al. Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg. 1995;81:385–8.

    Article  PubMed  CAS  Google Scholar 

  7. Sprung J, Whalley DG, Falcone T, et al. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth Analg. 2003;97:268–74.

    Article  PubMed  Google Scholar 

  8. Jones K. Can the morbidly obese have the same “standard of care”? Anesth Analg. 2003;97:603; author reply 603–4.

    Article  PubMed  Google Scholar 

  9. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology. 1997;86:24–33.

    Article  PubMed  CAS  Google Scholar 

  10. Davis K Jr, Branson RD, Campbell RS, et al. Comparison of volume control and pressure control ventilation: is flow waveform the difference? J Trauma. 1996;41:808–14.

    Article  PubMed  Google Scholar 

  11. Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care. 2002;47:416–24; discussion 424–6.

    PubMed  Google Scholar 

  12. Cole AG, Weller SF, Sykes MK. Inverse ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med. 1984;10:227–32.

    Article  PubMed  CAS  Google Scholar 

  13. Tharratt RS, Allen RP, Albertson TE. Pressure controlled inverse ratio ventilation in severe adult respiratory failure. Chest. 1988;94:755–62.

    Article  PubMed  CAS  Google Scholar 

  14. Gurevitch MJ, Van Dyke J, Young ES, et al. Improved oxygenation and lower peak airway pressure in severe adult respiratory distress syndrome. Treatment with inverse ratio ventilation. Chest. 1986;89:211–3.

    Article  PubMed  CAS  Google Scholar 

  15. Lessard MR, Guerot E, Lorino H, et al. Effects of pressure-controlled with different I:E ratios versus volume-controlled ventilation on respiratory mechanics, gas exchange, and hemodynamics in patients with adult respiratory distress syndrome. Anesthesiology. 1994;80:983–91.

    Article  PubMed  CAS  Google Scholar 

  16. Mancebo J, Vallverdu I, Bak E, et al. Volume-controlled ventilation and pressure-controlled inverse ratio ventilation: a comparison of their effects in ARDS patients. Monaldi Arch Chest Dis. 1994;49:201–7.

    PubMed  CAS  Google Scholar 

  17. Mang H, Kacmarek RM, Ritz R, et al. Cardiorespiratory effects of volume- and pressure-controlled ventilation at various I/E ratios in an acute lung injury model. Am J Respir Crit Care Med. 1995;151:731–6.

    PubMed  CAS  Google Scholar 

  18. Munoz J, Guerrero JE, Escalante JL, et al. Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow. Crit Care Med. 1993;21:1143–8.

    Article  PubMed  CAS  Google Scholar 

  19. Nyarwaya JB, Mazoit JX, Samii K. Are pulse oximetry and end-tidal carbon dioxide tension monitoring reliable during laparoscopic surgery? Anaesthesia. 1994;49:775–8.

    Article  PubMed  CAS  Google Scholar 

  20. Yamanaka MK, Sue DY. Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure. Chest. 1987;92:832–5.

    Article  PubMed  CAS  Google Scholar 

  21. Fleischmann E, Herbst F, Kugener A, et al. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology. 2006;104:944–9.

    Article  PubMed  Google Scholar 

  22. Hager H, Reddy D, Mandadi G, et al. Hypercapnia improves tissue oxygenation in morbidly obese surgical patients. Anesth Analg. 2006;103:677–81.

    Article  PubMed  Google Scholar 

Download references


This study was solely funded by institutional and departmental resources.

Author information

Authors and Affiliations


Corresponding author

Correspondence to L. E. C. De Baerdemaeker.

Additional information

Performed at the University Hospital of Ghent, Department of Anesthesia, Gent Belgium.

Preliminary results of this study were presented as poster discussion at the Euroanaesthesia meeting 2005 in Vienna, Austria.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

De Baerdemaeker, L.E.C., Van der Herten, C., Gillardin, J.M. et al. Comparison of Volume-controlled and Pressure-controlled Ventilation during Laparoscopic Gastric Banding in Morbidly Obese Patients. OBES SURG 18, 680–685 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: