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

Abstract

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 (P plat ) increased 1.78 ± 0.35 cmH 2 O 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 P plat and an increase in the MP better controlled with PCV-VG ventilation.