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. 2024 Apr 19;60(4):666.
doi: 10.3390/medicina60040666.

The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study

Nada Anđelić  1   2 , Arsen Uvelin  1   3 , Edita Stokić  3   4 , Radmila Popović  1   3 , Ranko Zdravković  3   5 , Andrej Preveden  3   5 , Nenad Zornić  2   6
Affiliations

The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study

Nada Anđelić et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The aim of this study was to examine whether the use of an alveolar recruitment maneuver (RM) leads to a significant increase in static lung compliance (Cstat) and an improvement in gas exchange in patients undergoing laparoscopic cholecystectomy. Material and Methods: A clinical prospective intervention study was conducted. Patients were divided into two groups according to their body mass index (BMI): normal-weight (group I) and pre-obese and obese grade I (group II). Lung mechanics were monitored (Cstat, dynamic compliance-Cdin, peak pressure-Ppeak, plateau pressure-Pplat, driving pressure-DP) alongside gas exchange, and hemodynamic changes (heart rate-HR, mean arterial pressure-MAP) at six time points: T1 (induction of anesthesia), T2 (formation of pneumoperitoneum), T3 (RM with a PEEP of 5 cm H2O), T4 (RM with a PEEP of 7 cm H2O), T5 (desufflation), and T6 (RM at the end). The RM was performed by increasing the peak pressure by +5 cm of H2O at an equal inspiration-to-expiration ratio (I/E = 1:1) and applying a PEEP of 5 and 7 cm of H2O. Results: Out of 96 patients, 33 belonged to group I and 63 to group II. An increase in Cstat values occurred after all three RMs. At each time point, the Cstat value was measured higher in group I than in group II. A higher increase in Cstat was observed in group II after the second and third RM. Cstat values were higher at the end of the surgical procedure compared to values after the induction of anesthesia. The RM led to a significant increase in PaO2 in both groups without changes in HR or MAP. Conclusions: During laparoscopic cholecystectomy, the application of RM leads to a significant increase in Cstat and an improvement in gas exchange. The prevention of atelectasis during anesthesia should be initiated immediately after the induction of anesthesia, using protective mechanical ventilation and RM.

Keywords: alveolar recruitment maneuver; laparoscopic cholecystectomy; static lung compliance.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Post-hoc analysis of static compliance of both groups measured at 6 time points.
Figure 2
Figure 2
Static lung compliance of group I and group II measured at 6 time points (x¯ ± 95% CI).
Figure 3
Figure 3
Post hoc (Bonferoni) analysis of HR in both groups at different time points (mean ± SD), * p < 0.001.
Figure 4
Figure 4
Post hoc (Bonferoni) analysis of MAP of both groups at different time points (median; 25–75. percentile), * p < 0.01.
See this image and copyright information in PMC

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