Positive End-Expiratory Pressure During Induction of General Anesthesia Increases Duration of Nonhypoxic Apnea in Morbidly Obese Patients

Positive end-expiratory pressure (PEEP) applied during induction of anesthesia prevents atelectasis formation and increases the duration of nonhypoxic apnea in nonobese patients. PEEP also prevents atelectasis formation in morbidlyobesepatients.Becausemorbidlyobesepatients have difficult airway management more often and because arterial desaturation develops rapidly, we studied the clinical benefit of PEEP applied during anesthesia induction. Thirty morbidly obese patients were randomly allocated to one of two groups. In the PEEP group, patients breathed 100% O2 through a continuous positive airway pressure device (10 cm H2O) for 5 min. After induction of anesthesia, they were mechanically ventilated with PEEP (10 cm H2O) for another 5 min until tracheal intubation. In the control group, the sequence was the same but without any continuous positive airway pressure or PEEP. We measured apnea duration until Spo2 reached 90% and we performed arterial blood gases analyses just before apnea and at 92% Spo2. Nonhypoxic apnea duration was longer in the PEEP group compared with the control group (188 46 versus 127 43 s; P 0.002).Pao2washigherbeforeapneainthePEEPgroup(P 0.038). Application of positive airway pressure during induction of general anesthesia in morbidly obese patients increases nonhypoxic apnea duration by 50%. (Anesth Analg 2005;100:580–4)