Positive end-expiratory pressure increases arterial oxygenation in elderly patients undergoing urological surgery using laryngeal mask airway in lithotomy position.
Elderly patients undergoing urological surgery in the lithotomy position may be vulnerable to perioperative hypoxemia. Positive end-expiratory pressure (PEEP) can improve arterial oxygenation. Although laryngeal mask airway (LMA) is widely utilized in urological surgery, it is not known how PEEP affects arterial oxygenation in these patients. We, therefore, evaluated the effect of PEEP on arterial oxygen partial pressure (PaO2) in elderly patients using LMA during urological surgery in the lithotomy position. Patients randomly received zero end-expiratory pressure (group Z, n = 34) or PEEP of 7 cmH2O (group P, n = 33). Ventilatory, respiratory, and haemodynamic variables were measured at 5 min (T0), 30 min (T1), and 60 min (T2) after LMA Supreme™ (sLMA) insertion. The primary outcome was the difference of PaO2 at T2 between the two groups. Atelectasis score, the incidence of a significant leak, and complications associated with sLMA insertion were also evaluated. PaO2 at T2 was significantly higher in group P than in group Z (20.0 ± 4.9 vs. 14.7 ± 3.7 kPa, P < 0.001). Atelectasis score at T2 was lower in group P than in group Z (5.3 ± 1.7 vs. 8.4 ± 2.3, P < 0.001). However, the incidence of a significant leak and complications associated with LMA insertion did not significantly differ between the two groups. PEEP can improve arterial oxygenation and reduce atelectasis in elderly patients using sLMA during urological surgery in the lithotomy position, suggesting that PEEP may be useful for elderly patients with an increased risk of perioperative hypoxemia when using sLMA.
['Kim|Doo-Hwan|DH|', 'Park|Jun-Young|JY|', 'Yu|Jihion|J|', 'Koh|Gi-Ho|GH|', 'Kim|Eunkyul|E|', 'Hwang|Jai-Hyun|JH|', 'Kim|Young-Kug|YK|http://orcid.org/0000-0002-1982-3053']
D000368:Aged D000758:Anesthesia D000768:Anesthesia, General D001784:Blood Gas Analysis D004311:Double-Blind Method D005260:Female D006439:Hemodynamics D006801:Humans D000860:Hypoxia D015994:Incidence D017214:Laryngeal Masks D008297:Male D010100:Oxygen D056888:Patient Positioning D011175:Positive-Pressure Respiration D011312:Pressure D001261:Pulmonary Atelectasis D012306:Risk D016683:Supine Position
Positive end-expiratory pressure Elderly patients Lithotomy position Arterial oxygen partial pressure LMA Supreme