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World Journal of Surgery
Published in: World Journal of Surgery 4/2006

01-04-2006

Impact of Overweight and Pneumoperitoneum on Hemodynamics and Oxygenation during Prolonged Laparoscopic Surgery

Authors: Dirk Meininger, MD, PhD, Bernhard Zwissler, MD, PhD, Christian Byhahn, MD, PhD, Michael Probst, MD, Klaus Westphal, MD, PhD, Dorothee H. Bremerich, MD, PhD

Published in: World Journal of Surgery | Issue 4/2006

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Abstract

Background

Anesthesia adversely affects respiratory function and hemodynamics in obese patients. Although many studies have been performed in morbidly obese patients, data are limited concerning overweight patients [BMI 25–29.9 kg m−2]. The aim of this study was to evaluate the effects of prolonged pneumoperitoneum in Trendelenburg position on hemodynamics and gas exchange in normal and overweight patients.

Methods

We studied 15 overweight and 15 non-obese [BMI 18.5–24.9 kg m−2] patients who underwent totally endoscopic robot-assisted radical prostatectomy under general anesthesia with an inspired oxygen fraction of 0.5. A standardized anesthetic regimen was used, and patients were examined at standard times: after induction of anesthesia and Trendelenburg posture, every 30 minutes after establishing pneumoperitoneum, and after the release of the pneumoperitoneum with the patient still in Trendelenburg position.

Results

After induction of anesthesia and Trendelenburg positioning arterial oxygen pressure [PaO2] and alveolar-arterial difference in oxygen tension [AaDO2] differed significantly between both groups with lower PaO2 [235 ± 27 versus 164 ± 51 mmHg] and higher AaDO2 [149 ± 48 versus 76 ± 28 mmHg] values in overweight patients. During pneumoperitoneum, PaO2 transient increased above baseline values in overweight patients, whereas AaDO2 decreased. Hemodynamic parameters [HR, MAP, and CVP] did not differ significantly between groups.

Conclusions

Arterial oxygenation and AaDO2 are significantly impaired in overweight patients under general anesthesia in Trendelenburg posture. In overweight patients pneumoperitoneum transient reduced the impairment of arterial oxygenation and lead to a decrease in AaDO2. Hemodynamic parameters were not affected by body weight.
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Metadata
Title
Impact of Overweight and Pneumoperitoneum on Hemodynamics and Oxygenation during Prolonged Laparoscopic Surgery
Authors
Dirk Meininger, MD, PhD
Bernhard Zwissler, MD, PhD
Christian Byhahn, MD, PhD
Michael Probst, MD
Klaus Westphal, MD, PhD
Dorothee H. Bremerich, MD, PhD
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 4/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0133-7

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