Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

Abstract

Background and objective: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. Method: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m 2 , age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10): individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10): individuals who received positive end-expiratory pressure of 10 cm H 2 O throughout the surgical procedure; and G-control (n = 20): not received any pre or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the postanesthetic recovery. Results: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H 2 O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. Conclusion: The use of positive end-expiratory pressure of 10 cm H 2 O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery. Use of positive pressure in bariatric surgery and effects on extubation time 131 PALAVRAS-CHAVE Doenças; Obesidade; Cirurgia bariátrica; Ventilação mecânica: pressão positiva Utilização da pressão positiva no pré e no intraoperatório de cirurgia bariátrica e seus efeitos sobre o tempo de extubaçãoResumo Justificativa e objetivo: Investigar a influência do uso da pressão positiva intraoperatória e pré-operatória no tempo de extubação de pacientes submetidos à cirurgia bariátrica. Método: Trata-se de ensaio clínico randomizado, no qual 40 indivíduos com índice de massa corporal entre 40 e 55 kg/m 2 , idade entre 25 e 55 anos, não tabagistas, submetidos à cirurgia bariátrica do tipo derivação gástrica em Y de Roux por laparotomia e com prova de função pulmonar pré-operatória dentro da normalidade foram randomizados nos seguintes grupos: G-pré (n = 10): indivíduos que receberam tratamento com pressão positiva não invasiva antes da cirurgia, durante uma hora, G-intra (n = 10): indivíduos que receberam Positive End-expiratory Pressure de 10 cm H 2 O durante todo o procedimento cirúrgico e G-controle (n = 20): não receberam qualquer tipo de intervenção pré ou intraoperatória. Foram anotados os seguintes tempos: tempo decorrido entre a indução anestésica e a extubação, entre o tér-mino da anestesia e extubação, tempo de ventilação mecânica, e tempo entre a extubação e a alta da Recuperação Pós-Anestésica. Resultados: Não houve diferença estatística entre os g...

Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis

“…The study by Baltieri et al [13] compared the use of PEEP 10 cmH 2 O versus PEEP 5 cmH 2 O and found no difference between the groups in LOS in the PACU, p = 0.21, (MD 36.00, 95% CI − 20.16 to 92.16; participants = 30; studies = 1; I 2 = 0%).…”

“…In the blinding of participants and personnel domain all the studies were classified as high risk as the personnel could not be blinded. Four studies [7,13,17,25] adequately described the blinding of outcome assessment. Eleven studies [7,[14][15][16][17][18][19][20][21]24, 25] did not describe losses or exclusions which could cause imbalance between the groups.…”

Non-invasive ventilation for preoxygenation before general anesthesia: a systematic review and meta-analysis of randomized controlled trials

“…However, most of these trials were excluded from our final review because of the following reasons: 13 used different interventions; 10 were review articles, 6 did not meet our patient selection criteria, 5 lacked control group and 1 provided no outcome of interest. Thus, 13 trials were eligible for inclusion in this study [28,[40][41][42][43][44][45][46][47][48][49][50][51].…”

“…Nine trials reported acceptable randomization methods. Outcome assessors were blinded to patient information in six trials [43,45,[47][48][49][50]. Outcome assessors were not blinded to patient information in the other seven trials.…”

“…Seven trials compared the PaO 2 outcome achieved after preoxygenation by using NIV and conventional methods [44,46,[48][49][50][51][52]. The NIV group exhibited a significantly more favorable PaO 2 than the conventional preoxygenation group (mean difference: 6.48, 95% CI: 2.81-10.15; Fig.…”