Intraoperative Valsalva maneuver: a narrative review

Area of Science:

• Physiology
• Cardiovascular Medicine
• Surgical Procedures

Background:

• The Valsalva maneuver (VM) is a physiological test involving forced expiratory effort against a closed airway.
• It induces significant, transient cardiovascular and autonomic nervous system changes.
• The VM is utilized in various clinical and surgical settings.

Purpose of the Study:

• To comprehensively review the existing literature on the Valsalva maneuver.
• To elucidate the complex physiologic alterations induced by the VM.
• To examine the intraoperative applications, potential complications, and preventive strategies associated with the VM.

Main Methods:

• Systematic review of published literature on the Valsalva maneuver.
• Analysis of studies detailing cardiovascular and physiological responses.
• Evaluation of case reports and studies on intraoperative use and complications.

Main Results:

• The VM causes distinct phases of cardiovascular changes, including initial hypertension, reflex bradycardia, and subsequent hypotension with compensatory tachycardia.
• Physiologic effects extend to respiratory, neurological, and gastrointestinal systems.
• While generally safe, rare complications such as syncope, arrhythmias, and aortic dissection have been documented.

Conclusions:

• The Valsalva maneuver elicits profound and predictable physiological responses.
• Understanding these responses is crucial for its effective diagnostic and therapeutic application.
• Awareness of potential complications and implementation of preventive measures are essential, particularly during intraoperative use.