Editorial Views  |   July 2019
Trendelenburg Position and Morbid Obesity: A Respiratory Challenge for the Anesthesiologist
Author Notes
  • From the Sorbonne University of Paris, Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine (J.-J.R., A.M., J.-M.C.) and Department of Multidisciplinary and Oncologic Radiology (O.L.), La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France; and University Clermont Auvergne, Department of Perioperative Medicine, University and Hospital Center of Clermont-Ferrand, France (J.-M.C.).
  • This editorial accompanies the article on p. 58.
    This editorial accompanies the article on p. 58.×
  • Accepted for publication April 6, 2019.
    Accepted for publication April 6, 2019.×
  • Address correspondence to Dr. Rouby: jjrouby@invivo.edu
Article Information
Editorial Views / Endocrine and Metabolic Systems / Respiratory System
Editorial Views   |   July 2019
Trendelenburg Position and Morbid Obesity: A Respiratory Challenge for the Anesthesiologist
Anesthesiology 7 2019, Vol.131, 10-13. doi:10.1097/ALN.0000000000002779
Anesthesiology 7 2019, Vol.131, 10-13. doi:10.1097/ALN.0000000000002779
In this issue of Anesthesiology, Grieco et al.1  bring evidence that pneumoperitoneum and the Trendelenburg position impose a dangerous stress on the respiratory system of morbidly obese patients undergoing robotic gynecologic surgery. In 22% of patients after Trendelenburg positioning, severe expiratory flow limitation and airway closure were observed, with airway opening pressures ranging between 17 and 32 cm H2O. The authors warn against the danger of using intraoperative pressure control ventilation, which could produce severe alveolar hypoventilation in patients with airway opening pressures greater than 15 cm H2O. More generally, the recent development of robotic-assisted surgery is, in obese patients, a serious challenge for the anesthesiologist.