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Background: Impaired respiratory functions during general anesthesia are commonly caused by lung atelectasis more in morbidly obese patients. This occurs more frequently with laparoscopic surgery due to trendelenburg position and pneumoperitoneum. Preemptive recruitment maneuver + PEEP results in the prevention of these changes. Aim: To quantitate the effects of RM and PEEP on intraoperative hypoxemia and respiratory mechanics during laparoscopic gastric banding in obese patients. Study Design: A randomized, double-blinded, controlled study. Method and Materials: Fifty adults ASA I-II, BMI (40-50 kg/m2) for elective laparoscopic gastric banding were randomized into, groups C, and RM, 25 patients each. Group C patients received standard ventilation, VT 6 ml/kg, I: E ratio 1: 2 PEEP 5 cm H2O, and respiratory rate 10-12 breaths/ min. RM patients received standard ventilation with one alveolar recruitment maneuver after mechanical ventilation with PEEP of 15 cm H2O till the end of the surgery. Heart rate, mean blood pressure, respiratory mechanical parameters: peak airway pressure, plateau pressure and end-expiratory lung volume, PaO2, PaO2/FiO2 and (SpO2) were assessed. Results: PaO2 and PaO2/FiO2 ratio increased significantly in the RM group after RM from T2 (before pneumoperitoneum) to T6 (end of surgery) compared with group C (P < 0.001). Peak and plateau airway pressures increased significantly in group C from T2 till T5 (60 min after pneumoperitoneum) compared with the RM group (P < 0.001). End-expiratory lung volume increased significantly in the RM group after RM compared with group C (P<0.001). Conclusion: Preemptive RM with PEEP of 15 cm H2O was effective in preventing pneumoperitoneum-induced intraoperative hypoxemia and respiratory mechanics changes.

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Background: Antifibrinolytic drugs, such as tranexamic acid are medications that facilitate hemostasis and decrease blood loss and the need for blood transfusion during major surgery. Activated recombinant coagulation factor VII is a novel hemostatic agent, studies revealed that it is helpful hemostatic in disorders with impaired hemostasis, as well as in patients with normal hemostatic function to minimize perioperative blood loss. This study aimed to compare the efficacy of activated recombinant factor VII with tranexamic acid in reducing the perioperative blood loss. Methods: 50 patients undergoing spine surgery were enrolled in this study. Group A patients were given activated recombinant factor VII and group T patients given tranexamic acid. In both groups, anesthesia was induced using fentanyl 3 lg/kg and propofol 2 mg/kg; muscle relaxation was initiated using cisatracurium 0.2 mg/kg. Transfusion of blood and its products was done according to a value guide. The primary outcome variable of the study was the total volume of blood loss in the perioperative period. Secondary outcome variables include perioperative transfusion requirement, and the number of patients who needed transfusion, as well as time of operation. A P-value less than 0.05 is considered statistically significant. Results: The current study showed that the total perioperative blood loss in group A was significantly lower than group T. None of the patients required ICU admission, as well as reentry to operating theater. Furthermore, no significant difference was detected in the number of patients needed blood transfusion. Intraoperative bleeding was associated with a slight decrease of hemoglobin in group A. Conclusion: The present study concluded that administration of activated recombinant factor VII in spine surgery reduces the total perioperative blood loss and the total volume of intraoperative blood transfusion compared with tranexamic acid, with no evidence of adverse effects.

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