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Total Respiratory System, Lung and Chest Wall Mechanics, Lung Volumes and Gas-Exchange in Morbidly Obese Patients During General Anesthesia

  • P. Pelosi
  • M. Croci
  • P. Vicardi
  • A. Lissoni
  • M. Cerisara

Abstract

Morbidly obese patients present an increased risk of developing anesthetic problems during surgery (1,2). Among them, respiratory comphcations should be carefully considered since these patients are particularly prone to developing severe hypoxemia, even in the absence of previously demonstrable intrinsic pulmonary disease (3). Respiratory comphcations may be caused not only by the surgical procedure itself, but also by the severe respiratory mechanical changes occurring during anesthesia and paralysis. Although the mechanical properties of the total respiratory system, the lung and the chest wall have been extensively investigated in spontaneously breathing patients (4-8), little attention has been given to the modifications occurring during anesthesia and paralysis.

Keywords

Obese Patient Lung Volume Airway Resistance Functional Residual Capacity Respiratory Mechanic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Fox GS, Whalley DG, Bevan OR (1981) Anesthesia for the morbidly obese: experience with 110 patients. Br J Anaesth 53:811–816PubMedCrossRefGoogle Scholar
  2. 2.
    Vaughan RW (1974) Anesthetic considerations in jejunoileal small bowel bypass for morbid obesity. Anesth Analg 53:421–429PubMedGoogle Scholar
  3. 3.
    Shenkman Z, Shir Y, Brodsky JB (1993) Perioperative management of the obese patient. Br J Anaesth 70:349–359PubMedCrossRefGoogle Scholar
  4. 4.
    Holley HS, Milic-Emih J, Becklake MR, Bates DV (1967) Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest 46:475–481PubMedCrossRefGoogle Scholar
  5. 5.
    Naimark A, Cherniack RM (1960) Compliance of the respiratory system and its components in health and obesity. J Appl Physiol 15:377–382PubMedGoogle Scholar
  6. 6.
    Suratt PM, Wilhoit SC, Hsiao HS, Atkinson RL, Rochester DF (1984) Comphance of chest wall in obese subjects. J Appl Physiol 57:403–407PubMedGoogle Scholar
  7. 7.
    Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ (1964) The total work of breathing in normal and obese men. J Clin Invest 43:728–739PubMedCrossRefGoogle Scholar
  8. 8.
    Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G (1993) Effects of obesity on respiratory resistance. Chest 103:1470–1476PubMedCrossRefGoogle Scholar
  9. 9.
    D’Angelo E, Robatto FM, Calderini E, Tavola M, Bono D, Torri G, Milic-Emili J (1991) Pulmonary and chest wall mechanics in anesthetized paralyzed humans. J Appl Physiol 70: 2602–2610PubMedGoogle Scholar
  10. 10.
    Bates JHT, Rossi A, Milic-Emili J (1985) Analysis of the behaviour of the respiratory system with constant inspiratory flow. J Appl Physiol 58:1840–1848PubMedGoogle Scholar
  11. 11.
    Pelosi P, Croci M, Ravagnan I, Cerisara M, Vicardi P, Lissoni A, Gattinoni L (1995) Analysis of behavior of the respiratory system in sedated-paralyzed morbidly obese patients: effects of flow, volume and time. J Appl Physiol (submitted)Google Scholar
  12. 12.
    Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L (1995) Total respiratory system, lung and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest (in press)Google Scholar
  13. 13.
    Damia G, Mascheroni D, Croci M, Tarenzi L (1988) Perioperative changes in the functional residual capacity in morbidly obese patients. Br J Anaesth 60:574–578PubMedCrossRefGoogle Scholar
  14. 14.
    Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ (1964) Effects of mass loading the respiratory system in man. J Appl Physiol 19:959–966PubMedGoogle Scholar
  15. 15.
    Said SI (1960) Abnormalities of pulmonary gas-exchange in obesity. Ann Intern Med 53: 1121–1129PubMedGoogle Scholar
  16. 16.
    Vaughan RW, Wise L (1976) Intraoperative arterial oxygenation in obese patients. Ann Surg 1184:35–42CrossRefGoogle Scholar
  17. 17.
    Luce JM (1980) Respiratory complications of obesity. Chest 78:626–631PubMedCrossRefGoogle Scholar
  18. 18.
    Fisher A, Waterhouse TD, Adams AP (1975) Obesity: its relation to anesthesia. Anesthesia 130:633–647CrossRefGoogle Scholar
  19. 19.
    Gilbert R, Auchincloss JH, Kuppinger M, Thomas M (1979) Stabihty of the arterial/alveolar oxygen partial pressure ratio. Crit Care Med 7:267–272PubMedCrossRefGoogle Scholar
  20. 20.
    Salem MR, Dalai FY, Zygmunt MP, Mathrubhutham M, Jacobs HK (1978) Does PEEP improve intraoperative arterial oxygenation in grossly obese patients? Anesthesiology 48: 280–281PubMedCrossRefGoogle Scholar
  21. 21.
    Pelosi P, Norsa A, Croci M, Vicardi P, Cerisara M, Gattinoni L (1995) Physiologic effects of positive end-expiratory pressure (PEEP) in postoperative sedated-paralyzed morbidly obese patients. Intensive Care Med (in press)Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • P. Pelosi
  • M. Croci
  • P. Vicardi
  • A. Lissoni
  • M. Cerisara

There are no affiliations available

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