Sequential alveolar recruitment maneuvers during laparoscopic radical prostatectomy: a pilot randomized control trial
Abstract
Background & objective: Lung atelectasis is a known complication of general anesthesia, and especially in patients undergoing laparoscopic surgical procedures. Respiratory system compliance (Crs) is a measured sign of lung atelectasis in laparoscopic surgery. A protocolized sequential alveolar recruitment maneuver (RM) with positive end-expiratory pressure (PEEP) was compared to a usual management.
Methodology: Patients scheduled for elective laparoscopic radical prostatectomy under extreme Trendelenburg position were randomly allocated to one of the two groups; either PEEP plus alveolar RM in every 30 min (RM group) or PEEP only (PEEP group). The primary outcome was the time-dependent differences in Crs between the groups, that was tested using multivariate analysis of variance (MANOVA).
Results: Between 19 patients in the RM group and 17 patients in the PEEP group, patients’ demography was balanced. The time depended difference in Crs was significantly higher in the RM group than in the non-RM group. Postoperative atelectasis occurred in one patient in the PEEP group, whose Crs was 34 cmH2O/mL at the time of intubation. In the subgroup with initial low Crs (< 60 cmH2O/mL), the time-dependent difference in Crs was significantly higher in the RM group than the PEEP group.
Conclusion: In the subgroup with initial low respiratory system compliance (< 60 cmH2O/mL), the time-dependent difference in respiratory system compliance was significantly higher in the RM group than in the PEEP group, suggesting that the therapeutic target of RM would be initially low respiratory system compliance patients.
Abbreviations: Crs - Respiratory system compliance; RM - recruitment maneuver; PEEP - positive end-expiratory pressure
Keywords: Respiratory System Compliance; Lung Recruitment Maneuver; Lung Mechanics; Atelectasis; Randomized Control Trial
Citation: Matsuki Y, Hosokawa K, Uchino A, Matsuda S, Shigemi K. Sequential alveolar recruitment maneuvers during laparoscopic radical prostatectomy: a pilot randomized control trial. Anaesth. pain intensive care 2024;28(2):329−332; DOI: 10.35975/apic.v28i2.2407
Received: February 16, 2024; Revised: February 16, 2024; Accepted: March 11, 2024
