Effect of pressure-controlled recruitment maneuver on hemodynamics and respiratory mechanics during pneumoperitoneum

INTRODUCTION: Laparoscopic surgery has become an increasingly preferred method due to the small size of the abdominal incision line, causing less tissue trauma, reduced post-operative analgesic requirement, providing early mobilization, decreased post-operative ileus, and shortened hospital stay. However, pneumoperitoneum may cause upward displacement of the diaphragm by increasing intra abdominal pressure, decrease functional residual capacity and lung compliance, and develop atelectasis. The aim of this study is to investigate the effect of recruitment maneuver and positive end expiratory pressure (PEEP) applications performed together with graduated pressure levels and low O2 concentration on respiratory mechanics, oxygenation, and hemodynamic parameters in patients who underwent laparoscopic cholecystectomy.
METHODS: Sixty patients with laparoscopic surgery and ASA I and II were divided into three groups (n=20 in each group). Recruitment maneuvers were performed in the patients in Group R with a stepwise method twice, 5 min after insufflation and desufflation. While the patients were at 8 cmH2O PEEP value, they were ventilated 10 times with 5 cmH2O < PEEP increments while the Ppeak<50 cmH2O up to 20 cmH2O PEEP value. The gradually increased PEEP value was reduced again gradually and terminated at the initial PEEP value of 8 cmH2O. In the patients in Group P, only 8 cmH2O PEEP was initiated after intubation and recruitment maneuver was not performed. On the other hand, PEEP was not initiated and recruitment maneuver was not performed in the patients in Group C after intubation. In all patients, 5 min after insufflation and desufflation, intraoperative arterial blood gas analysis was performed twice, and simultaneous static and dynamic compliance values and hemodynamic values (systolic, diastolic, mean arterial pressure, and heart rate) were recorded.
RESULTS: PaO2 values 5 min after insufflation and desufflation in Group C (insufflation: 156.65±43.21 and desufflation: 165.45±35.83) were detected significantly lower than Group R (insufflation: 199.50±29.32 and desufflation: 253.33±37.93) and Group P (insufflation: 200.93±58.16 and desufflation: 202.84±47.13) (p<0.05). PaO2 measurements 5 min after desufflation in the cases in the R group were found to be significantly higher than the cases in Group P (p<0.05). In the cases in Group R, the increase in the PaO2 value 5 min after desufflation was significantly higher to the PaO2 value 5 min after insufflation (p<0.05). The change in PaO2 values in the cases in Group P and Group K was not statistically significant (p>0.05). Compliance measurements of the cases in Group R 5 min after desuflation were found to be significantly higher than the cases in Groups P and C.
DISCUSSION AND CONCLUSION: It is thought that recruitment maneuver and PEEP application with gradually increasing pressure in patients undergoing laparoscopic surgery have positive effects on oxygenation, increases lung compliance and can be used safely.