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Joel R. Lopes Jr., M.D. Director Trauma/Critical Care Anesthesia Department Of Anesthesiology Boston University Medical

Joel R. Lopes Jr., M.D. Director Trauma/Critical Care Anesthesia Department Of Anesthesiology Boston University Medical Center. Mechanical Properties of the respiratory System in Morbidly Obese patients. Decreased Functional residual capacity Increased Intra-abdominal Pressure

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Joel R. Lopes Jr., M.D. Director Trauma/Critical Care Anesthesia Department Of Anesthesiology Boston University Medical

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  1. Joel R. Lopes Jr., M.D. Director Trauma/Critical Care Anesthesia Department Of Anesthesiology Boston University Medical Center

  2. Mechanical Properties of the respiratory System in Morbidly Obese patients • Decreased Functional residual capacity • Increased Intra-abdominal Pressure • Increased Alveolar-arterial Oxygenation gradient

  3. Supine Position under General Anesthesia HYPOXEMIA • FRC < Closing Capacity • Unopposed Intra-Abdominal Pressure

  4. Options for Ventilation • P.E.E.P. • Tidal Volume • Respiratory Rate

  5. P.E.E.P. • Maintain the highest mean PaO2 intraOp • NOT sustained postOp • ?benefits in the Morbidly Obese Yakaitis RW Anesth Analg 1975;54:427-32

  6. “Does PEEP Improve Intraoperative Arterial Oxygenation in Grossly Obese Patients?” • Constant Tidal Volume = 1000-1200cc • Respiratory Rate = 9–12/min • PEEP = 10 – 12cm H2O ABG analysis 5 minutes before and at 2, 4, 20, and 30 minutes following discontinuation of PEEP Salem MR Anesth 1978:48:280-81

  7. Effects of Discontinuing PEEP on A-a pO2 Salem MR Anesth 48:281,1978

  8. Discontinuation of PEEP resulted in significant increase in Arterial O2 tension • high Tidal Volumes • Redistribution of Pulmonary Blood flow • Increased intrathoracic press

  9. Gas Exchange at Different PEEP levels Normal Obese Pelosi P Anesth:1999:91,1228

  10. IntraAbd Press, Lung Volume, and Elastance at different Levels of PEEP Normal Obese Pelosi P Anesth 1999:91;1225

  11. Rev. Trendelenburg effect on Pao2 Perilli V Anesth Analg 2000;91:1520-3

  12. …Morbid Obesity, Pneumoperitoneum, and Posture on Respiratory Mechanics and Oxygenation During Laparoscopy Static Compliance Pneumoperitoneum, Sprung J.Anesth Analg 2002;94:1345-50

  13. A-a DO2 Sprung J Anesth Analg 2002;94:1345-50

  14. Effect of Tidal Volume and Respiratory Rate on Respiratory Mechanics During Laparoscopy… Tidal Volume Resp Rate Baseline Double Vt Double RR Sprung J Anesth Analg 2003;97:268-74

  15. Static Compliance in Normal Weight Patients Pneumoperitoneum Sprung J Anesth Analg 2003;97:268-74

  16. Static Compliance in Morbidly Obese Patients Pneumoperitoneum Sprung J Anesth Analg 2003;97:268-74

  17. Effect of Weight, Position, and Pneumoperitoneum on Alveolar-arterial difference in O2 tension mo A-aDO2 mmHg nw Pneumoperitoneum Sprung J Anesth Analg 2003;97:268-74

  18. Respiratory Rate P.E.E.P. 5-10cm H2O Adjust RR for EtCO2 = 32-40 Tidal Volume 10cc/kg IBW Pressure Control I : E

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