Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery

R Mato-Búa; A Prado-Rodríguez; D López-López; P Rama-Maceiras; N Molins-Gauna; F Álvarez-Refojo

doi:10.1016/j.redare.2024.03.006

Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery

Rev Esp Anestesiol Reanim (Engl Ed). 2024 Mar 5:S2341-1929(24)00059-3. doi: 10.1016/j.redare.2024.03.006. Online ahead of print.

Authors

R Mato-Búa¹, A Prado-Rodríguez², D López-López², P Rama-Maceiras², N Molins-Gauna², F Álvarez-Refojo²

Affiliations

¹ Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain. Electronic address: rocio.mato.bua@gmail.com.
² Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.

PMID: 38452926
DOI: 10.1016/j.redare.2024.03.006

Abstract

Introduction: Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact.

Methods: Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min.

Results: Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH₂O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH₂O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied.

Conclusion: In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.

Keywords: Alveolar arterial oxygen gradient; Alveolar recruitment; Atelectasia pulmonar; Gradiente alveoloarterial de oxígeno; Intercambio gaseoso pulmonar; PEEP; Positive end-expiratory pressure; Presión positiva al final de la espiración; Pulmonary atelectasis; Pulmonary gas exchange; Reclutamiento alveolar.