Anesthesiology
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Randomized Controlled Trial
Airway Closure during Surgical Pneumoperitoneum in Obese Patients.
Airway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia. ⋯ In obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.
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The use of Absalom and Kataria propofol TCI and Minto remifentanil TCI algorithms, along with processed EEG (BIS; Entropy), makes Total Intravenous Anaesthesia (TIVA) practical in children.
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