The effect of alveolar recruitment manoeuvre on intraoperative haemodynamics

Objective: Pneumoperitoneum and Trendelenburg position during laparoscopic hysterectomy increase intra-abdominal and intrathoracic pressure, decrease lung compliance and increase the risk of atelectasis. In our study, we aimed to evaluate the effect of recruitment manoeuvre (RM) on haemodynamics, lung compliance and oxygenation in laparoscopic hysterectomy patients. Method: After ethics committee approval, 70 ASA I-II patients scheduled for elective laparoscopic hysterectomy were included in the study. In addition to standard anaesthesia monitoring, radial artery cannulation was performed and arterial waveform analysis and cardiac output (CO) monitoring were performed. After routine induction of general anaesthesia and intubation, patients were divided into 2 groups as RM treated (Group I) and non-treated (Group II). Patients in Group I received stepwise RM twice in the intraoperative period. Haemodynamic parameters, blood gases and compliance were recorded during the operation. Duration of surgery, anaesthesia and post anaesthesia care unit (PACU) stay were recorded and patients were evaluated for pulmonary complications on postoperative days 1 and 3. Results: Demographic data were similar. There was no difference in anaesthesia, surgery and length of stay in the PACU (p>0,05). The need for positive inotropes and the amount of fluid given intraoperatively were similar in Group I and Group II. Although heart rate (HR) was similar between the groups, mean arterial pressure (MAP), cardiac index (CI) and stroke volume index (SVI) were higher in Group I and stroke volume variation (SVV), pulse pressure variation (PVV) and systemic vascular resistance index (SVRI) were lower in Group I compared to Group II (p<0,05). These haemodynamic changes were more pronounced at peak pressure level during RM in Group I (p<0,05). RM in Group I also significantly increased the dynamic compliance of the lung (Cdyn), PaO2 and PaO2/FiO2 ratios (p<0,05). Conclusion: It has been observed that RM applied in laparoscopic hysterectomies improves intraoperative lung compliance and oxygenation without causing clinically severe haemodynamic instability. Therefore, we believe that intraoperative application of RM in laparoscopic surgeries will be beneficial. Key words: Alveolar Recruitment Manoeuvre, Haemodynamics, Oxygenation, Compliance, Laparoscopic Surgery