Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients
Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients
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DOI：
10.1213/01.ane.0000143339.40385.1b
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发表时间：
2005-02-01
影响因子：
5.7
通讯作者：
Magnusson, L
中科院分区：
文献类型：
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作者：
Gander, S;Frascarolo, P;Magnusson, L
在非肥胖患者中，麻醉诱导期间应用呼气末正压（PEEP）可预防肺不张形成并延长非缺氧性呼吸暂停的持续时间。PEEP还可预防病态肥胖患者的肺不张形成。由于病态肥胖患者的气道管理更困难，并且动脉去饱和发展迅速，我们研究了麻醉诱导期间应用PEEP的临床益处。30例病态肥胖患者随机分为两组。PEEP组采用100%O2持续正压通气（10 cm H2O）5 min，麻醉诱导后继续机械通气（10 cm H2O）5 min，直至气管插管。在对照组中，顺序相同，但没有任何持续气道正压或PEEP。我们测量了Spo（2）达到90%之前的呼吸暂停持续时间，并在呼吸暂停前和Spo（2）达到92%时进行了动脉血气分析。PEEP组非缺氧性呼吸暂停持续时间较对照组长（188 +/- 46 vs 127 +/- 43 s; P = 0.002）。PEEP组呼吸暂停前Pao（2）高于对照组（P = 0.038）。在病态肥胖患者全麻诱导期间应用气道正压通气可使非缺氧性呼吸暂停持续时间增加50%。
Positive end-expiratory pressure (PEEP) applied during induction of anesthesia prevents atelectasis formation and increases the duration of nonhypoxic apnea in nonobese patients. PEEP also prevents atelectasis formation in morbidly obese patients. Because morbidly obese patients have difficult airway management more often and because arterial desaturation develops rapidly, we studied the clinical benefit of PEEP applied during anesthesia induction. Thirty morbidly obese patients were randomly allocated to one of two groups. In the PEEP group, patients breathed 100% O-2 through a continuous positive airway pressure device (10 cm H2O) for 5 min. After induction of anesthesia, they were mechanically ventilated with PEEP (10 cm H2O) for another 5 min until tracheal intubation. In the control group, the sequence was the same but without any continuous positive airway pressure or PEEP. We measured apnea duration until Spo(2) reached 90% and we performed arterial blood gases analyses just before apnea and at 92% Spo(2). Nonhypoxic apnea duration was longer in the PEEP group compared with the control group (188 +/- 46 versus 127 +/- 43 s; P = 0.002). Pao(2) was higher before apnea in the PEEP group (P = 0.038). Application of positive airway pressure during induction of general anesthesia in morbidly obese patients increases nonhypoxic apnea duration by 50%.