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Respiration, circulation and anaesthetic management in obesity. Investigation before and after jejunoileal bypass
Insights
Very obese patients often have impaired lung function and circulatory issues. Weight reduction surgery improved some parameters but persistent ventilatory disturbances highlight the need for careful preoperative evaluation and respiratory care in obese surgical patients.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Bariatric Surgery
Background:
- Obesity is associated with significant physiological changes affecting multiple organ systems.
- Understanding the impact of obesity on ventilatory and circulatory function is crucial for surgical risk assessment.
Purpose of the Study:
- To investigate the effects of weight reduction following jejunoileal bypass on ventilatory and circulatory parameters in severely obese patients.
- To assess the persistence of physiological disturbances after significant weight loss.
Main Methods:
- Studied 17 very obese patients before and after jejunoileal bypass surgery.
- Assessed ventilatory parameters including vital capacity and lung function tests.
- Evaluated circulatory parameters such as blood volume, cardiac output, and arterial blood pressure.
Main Results:
- Preoperative findings included low vital capacity, impaired lung function, intrapulmonary shunting, and increased alveolar-arterial Po2 difference.
- Spirometric values improved post-surgery, but ventilatory disturbances persisted.
- Total blood volume per kg body weight increased after weight reduction, and arterial blood pressure decreased significantly.
Conclusions:
- Jejunoileal bypass leads to some improvements in ventilatory and circulatory parameters in obese patients.
- Persistent ventilatory disturbances underscore the importance of preoperative evaluation and respiratory care for obese patients undergoing surgery.
- Weight reduction positively impacts blood volume distribution and arterial blood pressure in this population.
Abstract:
Some ventilatory and circulatory parameters were studied in 17 very obese patients before and after weight reduction following jejunoileal bypass. A low vital capacity and signs of impaired lung function with intrapulmonary shunting, increased alveolar-arterial Po2 difference and low Pao2 were found. Although the spirometric values improved significantly after weight reduction, the ventilatory disturbance persisted. A normal response to inhalation of CO2 was seen. The total blood volume was high and did not change after weight reduction. However, if calculated as blood volume per kg body weight, the values were lower than normal, and they increased as a consequence of weight reduction. Cardiac output was slightly lower than normal in relation to oxygen consumption. Total peripheral resistance was normal. Arterial blood pressure, which was in the high normal range preoperatively, decreased significantly after weight reduction. Total doses of intravenous anaesthetic agents and muscle relaxants were the same as for patients of normal weight. The importance of preoperative evaluation and of respiratory care of obese patients undergoing elective surgery is stressed.