Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Laparoskopik Sleeve Gastrektomi Uygulanan Morbid Obez Hastalarda Basınç Kontrollü ve Hacim Kontrollü Ventilasyonun Karşılaştırılması: Randomize Kontrollü Bir Çalışma
Comparison of Pressure Controlled and Volume Controlled Ventilation in Morbidly Obese Patients Underwent Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial
Pınar SAYINa, Hacer Şebnem TüRKa, Mustafa ALTINAYa, Melis TüRKEL ÖZKANa, Mehmet MİHMANLIb, Surhan ÇINARa
aClinic of Anesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, TURKEY
bClinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(2):109-18
doi: 10.5336/medsci.2020-80110
Article Language: TR
Full Text
ÖZET
 Amaç: Laparoskopik sleeve gastrektomi uygulanan morbid obez hastalarda, operasyon sırasında uygulanan basınç kontrollü ventilasyon (BKV) ve hacim kontrollü ventilasyonun (HKV) kan gazı ve solunum mekaniği üzerindeki etkisini karşılaştırmak. Gereç ve Yöntemler: Beden kitle indeksi 35'ten fazla olan 100 hasta BKV (Grup A) ve HKV (Grup B) gruplarına ayrıldı. Kalp atım hızı, ortalama arter basıncı, SpO2, end-tidal CO2, tidal hacim, frekans, Ppeak, Pplateau ve kompliyans değerleri başlangıçta, CO2 insüflasyonu sonrası her 15 dk'da bir ve insüflasyonun sona ermesinden sonraki 15. dk'da kaydedildi. Arteriyel kan gazı örnekleri başlangıçta, insüflasyondan sonraki 15. ve 60. dk'larda ve insüflasyonun sona ermesinden sonraki 15. dk'da alındı. Bulgular: Ortalama Ppeak ve Pplateau seviyeleri, tüm ölçüm noktalarında Grup A'da Grup B'den anlamlı derecede düşüktü. BKV ayrıca insüflasyonun 15. dk'sında ve operasyon sonunda kompliyansı artırdı. PH, PaO2, PCO2, HCO3, BE, PAO2-PaO2 ortalama değerleri açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu. Sonuç: Laparoskopik sleeve gastrektomide BKV modunda düşük Ppeak ve Pplateau seviyeleri ve artmış kompliyans değerleri gözlendi. BKV modunun perioperatif dönemde HKV'ye göre avantaj sağladığı saptandı.

Anahtar Kelimeler: Obezite; laparoskopi; gastrektomi; ventilasyon stratejisi
ABSTRACT
 Objective: To compare the influence of pressure controlled ventilation (PCV) and the volume controlled ventilation (VCV) on blood gas and respiratory mechanics during the operation in morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Material and Methods: One hundred patients who had a body mass index above 35 were divided into PCV (Group A) and VCV groups (Group B). Heart rate, mean arterial pressure, SpO2, end-tidal CO2, tidal volume, frequency, Ppeak, Pplateau, compliance values were recorded at baseline, in every 15 minutes after the CO2 insufflation and at 15th minute after the termination of the insufflation for each patient. Arterial blood gas samples were obtained at baseline, in the 15th and 60th minutes after the insufflation and at 15th minute after the termination of the insufflation. Results: The mean levels of Ppeak and Pplateau were significantly lower in Group A than Group B in all measurement points. The PCV also increased compliance at 15th min of insufflation and at the end of operation. There was no significant difference between the groups regarding the mean values of pH, PaO2, PCO2, HCO3, BE, PAO2-PaO2. Conclusion: In laparoscopic sleeve gastrectomy, the PCV mode decreased Ppeak and Pplateau levels and increased compliance. The PVC found to have an advantage to VCV during the perioperative period.

Keywords: Obesity; laparoscopy; gastrectomy; ventilation strategy
REFERENCES:
  1. Dion JM, McKee C, Tobias JD, Sohner P, Herz D, Teich S, et al. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes. Int J Clin Exp Med. 2014;7(8):2242-7. [PubMed] [PMC] 
  2. Oti C, Mahendran M, Sabir N. Anaesthesia for laparoscopic surgery. Br J Hosp Med (Lond). 2016;77(1):24-8. [Crossref] [PubMed] 
  3. Candiotti K, Sharma S, Shankar R. Obesity, obstructive sleep apnoea, and diabetes mellitus: anaesthetic implications. Br J Anaesth. 2009;103 Suppl 1:i23-30. [Crossref] [PubMed] 
  4. Shenkman Z, Shir Y, Brodsky JB. Perioperative management of the obese patient. Br J Anaesth. 1993;70(3):349-59. [Crossref] [PubMed] 
  5. Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg. 2007;31(3):556-60; discussion 561. [Crossref] [PubMed] 
  6. Sümer I, Topuz U, Alver S, Umutoglu T, Bakan M, Zengin SÜ, et al. Effect of the "Recruitment" Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery. Obes Surg. 2020;30(7):2684-92. [Crossref] [PubMed] [PMC] 
  7. Aldenkortt M, Lysakowski C, Elia N, Brochard L, Tramèr MR. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Br J Anaesth. 2012;109(4):493-502. [Crossref] [PubMed] 
  8. Wang C, Zhao N, Wang W, Guo L, Guo L, Chi C, et al. Intraoperative mechanical ventilation strategies for obese patients: a systematic review and network meta-analysis. Obes Rev. 2015;16(6):508-17. [Crossref] [PubMed] 
  9. Toker MK, Altıparmak B, Uysal Aİ, Demirbilek SG. Comparação entre ventilação garantida por volume controlado por pressão e ventilação controlada por volume em pacientes obesos durante cirurgia laparoscópica ginecológica na posição de Trendelenburg [Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position]. Rev Bras Anestesiol. 2019;69(6):553-560. Portuguese. [Crossref] [PubMed] 
  10. Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care. 2002;47(4):416-24; discussion 424-6. [PubMed] 
  11. Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95(6):1793-805. [Crossref] [PubMed] 
  12. Prella M, Feihl F, Domenighetti G. Effects of short-term pressure-controlled ventilation on gas exchange, airway pressures, and gas distribution in patients with acute lung injury/ARDS: comparison with volume-controlled ventilation. Chest. 2002;122(4):1382-8. Erratum in: Chest. 2003;123(1):315. [Crossref] [PubMed] 
  13. Ozyurt E, Kavakli AS, Ozturk NK. Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico [Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial]. Rev Bras Anestesiol. 2019;69(6):546-52. Portuguese. [Crossref] [PubMed] 
  14. Hans GA, Prégaldien AA, Kaba A, Sottiaux TM, DeRoover A, Lamy ML, et al. Pressure-controlled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery. Obes Surg. 2008;18(1):71-6. [Crossref] [PubMed] 
  15. De Baerdemaeker LE, Van der Herten C, Gillardin JM, Pattyn P, Mortier EP, Szegedi LL. Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients. Obes Surg. 2008;18(6):680-5. [Crossref] [PubMed] 
  16. Futier E, Constantin JM, Pelosi P, Chanques G, Kwiatkoskwi F, Jaber S, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology. 2010;113(6):1310-9. [Crossref] [PubMed] 
  17. Nielsen J, Østergaard M, Kjaergaard J, Tingleff J, Berthelsen PG, Nygård E, et al. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med. 2005;31(9):1189-94. [Crossref] [PubMed] 

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