Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
-
Surg Obes Relat Dis · Feb 2021
Randomized Controlled TrialDuration of safe apnea in patients with morbid obesity during passive oxygenation using high-flow nasal insufflation versus regular flow nasal insufflation, a randomized trial.
Obese patients are at risk for rapid oxygen desaturation during anesthesia induction. Apneic oxygenation with regular flow oxygen insufflation has successfully been used to prolong the duration of safe apnea without desaturation (DAWD) in morbidly obese patients. Using high-flown nasal insufflation of oxygen (HFNI) for apneic oxygenation might further increase the DAWD. ⋯ Compared with standard nasal apneic oxygenation, HFNI did not increase the duration of safe apnea in patients with morbid obesity. A significant but clinically negligible higher airway pressure was observed when using HFNI.
-
Surg Obes Relat Dis · Feb 2021
Randomized Controlled TrialThe use of intraoperative bedside lung ultrasound in optimizing positive end expiratory pressure in obese patients undergoing laparoscopic bariatric surgeries.
Anesthetic management of patients with obesity undergoing laparoscopic abdominal surgeries requires careful plan for intraoperative mechanical ventilation aiming to avoid lung atelectasis and/or overdistention. There are conflicting data on the optimum positive end expiratory pressure (PEEP) during these surgeries. We hypothesized that lung ultrasound could be used for PEEP titration during laparoscopic surgery. ⋯ In patients with obesity undergoing laparoscopic bariatric surgery, the use of lung ultrasound individualized stepwise PEEP approach improved oxygenation, compliance and reduced the incidence of postoperative pulmonary atelectasis and hypoxia without causing hemodynamic instability.