Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy.
Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy -
Minerva Anestesiol. 2023 Sep;89(9):733-743. doi: 10.23736/S0375-9393.22.17006-9. Epub 2023 Feb 7.
Laparoscopic surgery and Trendelenburg position may affect the respiratory function and alter the gas exchange. Further the reduction of the lung volumes may contribute to the development of expiratory flow limitation (EFL). The latter is associated with an increased risk of postoperative pulmonary complications. Our aim was to investigate the incidence of EFL and to evaluate its effect on pulmonary function and intraoperative V/Q mismatch.
This is a prospective study on patients undergoing elective laparoscopic gynecological surgery. We evaluated respiratory mechanics, V/Q mismatch and presence of EFL after anesthesia induction, during pneumoperitoneum and Trendelenburg position and at the end of surgery. Intraoperative gas exchange and hemodynamic were also recorded. Clinical data were collected until seven days after surgery to evaluate the onset of pulmonary postoperative complications (PPCs).
Among the 66 patients enrolled, 25/66 (38%) exhibited EFL during surgery, of whom 10/66 (15%) after anesthesia induction, and the remaining 15 patients after pneumoperitoneum and Trendelenburg position. Median PEEP able to reverse flow limitation was 7 [7-10] cmH2O after anesthesia induction and 9 [8-15] cmH2O after pneumoperitoneum and Trendelenburg position. Patients with EFL had significantly higher shunt (17 [2-25] vs. 9 [1-19]; P=0.05), low V̇/Q̇ (27 [20-70] vs. 15 [10-22]; P=0.05) and high V̇/Q̇ (10 [7-14] vs. 6 [4-7]; P=0.024). At the end of surgery, only high V/Q was significantly higher in EFL patients. Further, they exhibited higher incidence of postoperative pulmonary complication (48% (12/25) vs. 15% (6/41), P=0.005), hypoxemia and hypercapnia (80% [20/25] vs. 32% [13/41]; P<0.001).
Expiratory flow limitation is a common phenomenon during gynecological laparoscopic surgery associated with worsen gas exchange, increased V/Q mismatch and altered lung mechanics. Our study showed that patients experiencing EFL during surgery showed a higher risk for PPCs.
腹腔镜手术和头高脚低位可能会影响呼吸功能，改变气体交换。进一步的肺容积减少可能导致呼气流量受限（EFL）的发展。后者与术后肺部并发症（PPCs）的风险增加有关。我们的目的是调查 EFL 的发生率，并评估其对肺功能和术中 V/Q 不匹配的影响。
这是一项对接受择期腹腔镜妇科手术的患者进行的前瞻性研究。我们在麻醉诱导后、气腹和头高脚低位期间以及手术结束时评估呼吸力学、V/Q 不匹配和 EFL 的存在。术中还记录了气体交换和血液动力学。收集临床数据直到术后 7 天，以评估 PPCs 的发生。
在纳入的 66 名患者中，有 25/66（38%）在手术期间出现 EFL，其中 10/66（15%）在麻醉诱导后，其余 15 名患者在气腹和头高脚低位后出现 EFL。能够逆转流量限制的中位 PEEP 为麻醉诱导后 7 [7-10] cmH2O，气腹和头高脚低位后 9 [8-15] cmH2O。存在 EFL 的患者的分流量明显更高（17 [2-25] 比 9 [1-19]；P=0.05），低 V̇/Q̇（27 [20-70] 比 15 [10-22]；P=0.05）和高 V̇/Q̇（10 [7-14] 比 6 [4-7]；P=0.024）。在手术结束时，只有 EFL 患者的高 V/Q 显著更高。此外，他们术后肺部并发症的发生率更高（48%（12/25）比 15%（6/41），P=0.005），低氧血症和高碳酸血症（80%（20/25）比 32%（13/41）；P<0.001）。
呼气流量受限是妇科腹腔镜手术中常见的现象，与气体交换恶化、V/Q 不匹配增加和肺力学改变有关。我们的研究表明，术中出现 EFL 的患者 PPCs 的风险更高。
