Effect of Rectus Plication during Abdominoplasty on the Mechanical Power and Airway Pressures: Comparison of Two Ventilatory Strategies

Background: Abdominoplasty is a commonly requested procedure for aesthetic improvement of the affected soft tissue layers of skin, fat, and muscle through the slightest incision feasible. The degree of plicature generates an increase in intraabdominal pressure that causes an increase in intrathoracic pressure. Pressure, volume, flow, and respiratory rate are components of a unique physical variable, the mechanical power (MP), and is an integrated variable linked to most factors related to postoperative pulmonary complications. Purpose: To assess the effect of rectus plication (RP) during abdominoplasty on lung pressures and the contribution to increasing the MP. Method: A open-label study was conducted at TJ Plast Advanced Center for Plastic Surgery in Tijuana, México, from September 2021 to May 2022. The study included forty-six female patients subjected to abdominoplasty or liposuction with abdominoplasty. After the induction of general anesthesia and neuromuscular blockade, they were allocated into two groups: Group 1 pressure control ventilation-volume guaranteed (PCV-VG) and Group 2 volume control ventilation (VCV). Respiratory pressures and MP were assessed before and after RP. Results: During VCV, patients had a greater increase in peak pressure (PIP) (P 0.000). Plateau pressure (Pplat) increased 1.78 ± 0.35 cmH2O in group 2 after RP (P = 0.001). MP had a greater increase in group 2 after RP (P 0.01). Conclusion: This prospective study showed that RP is related to an increase in PIP and Pplat and an increase in the MP better controlled with PCV-VG ventilation.

Assessment of intraoperative oxygenation function and trauma degree of PCV-VG and VCV mode for elderly patients with laparoscopic abdominal surgery

Objective:To study the intraoperative oxygenation function and trauma degree of pressure-controlled ventilation-volume guaranteed (PCV-VG) and volume-controlled ventilation (VCV) mode for elderly patients with laparoscopic abdominal surgery. Methods:60 elderly patients with laparoscopic abdominal surgery were selected for study and randomly divided into two groups (n=30), group A received ventilation in accordance with sequential VCV-PCV-VG mode, group B received ventilation in accordance with the sequential PCV-VG-VCV mode, and the respiratory function parameters and arterial blood gas parameters and serum damage indexes were determined before the start of pneumoperitoneum (T0), 1 h after the start of the first ventilation mode after the start of pneumoperitoneum (T1), 1 h after the switch of ventilation mode (T2) and after the end of pneumoperitoneum (T3). Results:At T1, Ppeak, mean airway pressure (Pmean) and plateau airway pressure (Pplant) of group A were significantly higher than those of group B (P<0.05), partial pressure of oxygen (PaO2) was significantly lower than that of group B (P<0.05), and pulse oxygen saturation (SpO2) and partial pressure of carbon dioxide (PaCO2) were not significantly different from those of group B;at T2 and T3, Ppeak, Pmean and Pplant of group A were significantly lower than those of group B (P<0.05), PaO2 were significantly lower than those of group B (P<0.05), and SpO2 and PaCO2 were not significantly different from those of group B. At T1, serum soluble receptor for advanced glycation end-product (sRAGE), KL-6 (krebs. von den Iungen-6), tumor necrosis factor-α(TNF-α) and malondialdehyde (MDA) content of group A were significantly higher than those of group B (P<0.05);at T3, serum sRAGE, KL-6, TNF-αand MDA content of group A were significantly lower than those of group B (P<0.05). Conclusions:PCV-VG mode for elderly patients with laparoscopic abdominal surgery can reduce airway pressure, improve lung compliance and alveolar oxidation, and reduce lung injury and systemic trauma.