Jon Cerami

Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper

School

School of Nursing

Department

Nursing

Date of Original Version

12-1-2019

Abstract

General anesthesia has a profound effect on respiratory dynamics in the obese population. Obesity can contribute to a decreased functional residual capacity, reduced lung volumes, and an increased closing capacity. Positioning and procedural requirements can further complicate the respiratory status of the obese patient. Surgical procedures in the obese population have an increased risk for the formation of atelectasis. Ventilation can be compromised due to atelectatic lung tissue and may result in post operative complications such as pneumonia, acute respiratory distress, hypoxia, a prolonged hospital stay, and the need for prolonged mechanical ventilation. Positive end-expiratory pressure (PEEP) is utilized in the operating room to increase arterial oxygenation, prevent airway collapse and expand alveoli during each breath. Alveolar recruitment maneuvers can be supplementary throughout surgical procedures to recruit and restore atelectatic lung tissue and prevent further formation of atelectasis. The purpose of this systematic review was to evaluate the effect of PEEP with recruitment maneuvers in obese patients undergoing abdominal surgery with general anesthesia. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Review and Meta- Analysis (PRISMA) Statement. Randomized control trials included in this systematic review were appraised using the Critical Appraisal Skills Programme (CASP) to evaluate reliability. Alveolar recruitment maneuvers increase lung compliance, arterial oxygenation, and decrease complications associated with atelectasis formation. The use of PEEP with alveolar recruitment maneuvers should be employed for obese patients that undergo abdominal surgery with general anesthesia.

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