Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients.

BACKGROUND: Respiratory function is impaired in obese patients undergoing laparoscopic surgery. This study was performed to determine whether repeated lung recruitment combined with PEEP improves respiratory compliance and arterial partial pressure of oxygen (Pa(O2)) in obese patients undergoing laparoscopic gastric banding.

METHODS: Sixty patients with BMI >30 kg m(-2) were randomized, after induction of pneumoperitoneum, to receive either PEEP of 10 cm H2O (Group P), inspiratory pressure of 40 cm H2O for 15 s once (Group R), Group R recruitment followed by PEEP 10 cm H2O (Group RP), or Group RP recruitment but with the inspiratory manoeuvre repeated every 10 min (Group RRP). Static respiratory compliance and Pa(O2) were determined after intubation, 10 min after pneumoperitoneum (before lung recruitment), and every 10 min thereafter (after recruitment). Results are presented as mean (SD).

RESULTS: Pneumoperitoneum decreased respiratory compliance from 48 (3) to 30 (1) ml cm H2O(-1) and decreased Pa(O2) from 12.4 (0.3) to 8.8 (0.3) kPa in all groups (P<0.01). Immediately after recruitment, compliance was 32 (1), 32 (2), 40 (2), and 40 (1) ml cm H2O(-1) and Pa(O2) was 9.1 (0.3), 9.1 (0.1), 11.9 (0.1), and 11.9 (0.1) kPa in Groups P, R, RP, and RRP, respectively (P<0.01). Ten and 20 min later, Pa(O2) in Group R decreased to 9.2 (0.1) kPa and compliance in Group PR decreased to 33 (2) ml cm H2O(-1), respectively (P<0.01).

CONCLUSIONS: Group RRP recruitment strategy was associated with the best intraoperative respiratory compliance and Pa(O2) in obese patients undergoing laparoscopic gastric banding.