Einfluss unterschiedlicher endexspiratorischer Drücke auf den Gasaustausch von Patienten mit moderater Adipositas oder Nikotinabusus unter Verwendung der ProSeal-Kehlkopfmaske für die kontrollierte Beatmung unter Allgemeinanästhesie
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Philipps-Universität Marburg
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Abstract
Background:
Pulmonary gas exchange under general anesthesia and pressure controlled ventilation is limited for the appearance of atelectasis and airway collapse. A recruitment maneuver followed by the application of positive end-expiratory pressure (PEEP) can re-open collapsed alveoli and prevent atelectasis in obese patients or in patients with pulmonary disease.
Under the utilization of the classic laryngeal mask (CLMA) pressure controlled ventilation was limited. The ProSeal laryngeal mask (PLMA) forms a more effective seal of the airway than the CLMA. It has been shown that the application of PEEP when PCV is used with the PLMA is possible in adult patients. In obese patients or patients with pulmonary disease it could have an impact on oxygenation.
Methods:
Study 1: 70 patients (age: 49 ± 13 years, body mass index: 33 ± 2 kg/m²)without smoking history or pulmonary disease who would undergo general anesthesia under the use of PLMA were recruited. The BIS guided anaesthesia technique was with Propofol, Fentanyl, and Remifentanil without muscle relaxants. PLMA seal pressure measurement served as recruitment maneuver. PCV was randomly combined with 0 cm H2O, 5 cm H2O or 8 cm H2O of end-expiratoy pressure. Fifty minutes after induction of anaesthesia an arterial blood gas sample was taken under FiO2=0.3. In the first part, PaO2 under 0 cm H2O was compared with PaO2 under 5 cm H2O; in the second part PaO2 under 5 cm H2O was compared with PaO2 under 8 cm H2O.
Study 2: 74 patients with smoking history and normal weight (age: 37 ± 13 years) were recruited. PLMA seal pressure measurement served as recruitment maneuver. PCV was randomly combined with 0 cm H2O, 5 cm H2O or 8 cm H2O of end-expiratoy pressure. Fifty minutes after induction of anaesthesia an arterial blood gas sample was taken under FiO2=0.3. In the first part, PaO2 under 0 cm H2O was compared with PaO2 under 5 cm H2O; in the second part PaO2 under 5 cm H2O was compared with PaO2 under 8 cm H2O.
Results:
Study 1: Demographic data, circulation and ventilation data were comparable between corresponding groups. The PLMA could be placed with three attempts and the application of randomized PEEP was possible in all patients. Significant differences in PaO2 were found in part one (75 ± 12 mmHg vs. 94 ± 18 mmHg; p=0,02) as well as part two (92 ± 21 mmHg vs. 103 ± 18 mmHg; p=0,04).
Study 2: Demographic data, circulation and ventilation data were comparable between corresponding groups. The PLMA could be placed with three attempts and the application of randomized PEEP was possible in all patients. No significant differences in PaO2 or PaCO2 were found between corresponding groups (p≥0,05).
Conclusions:
The application of PEEP when PCV is used with the PLMA results in improved oyxgenation in obese patients but not in normal weight patients with smoking history.
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Dates
Created: 2011Issued: 2011-04-29Updated: 2011-08-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
AtelectasisPositive end-expiratoy pressureLaryngeal mask airwayControlled ventilation
DFG-subjects
FettsuchtAnästhesieNicotinAtemmaskeKünstliche BeatmungAtelektase
DDC-Numbers
610
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Gerlach, Marieke (1012600572): Einfluss unterschiedlicher endexspiratorischer Drücke auf den Gasaustausch von Patienten mit moderater Adipositas oder Nikotinabusus unter Verwendung der ProSeal-Kehlkopfmaske für die kontrollierte Beatmung unter Allgemeinanästhesie. : Philipps-Universität Marburg 2011-04-29. DOI: https://doi.org/10.17192/z2011.0346.
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This item has been published with the following license: In Copyright