The effect of alveolar recruitment maneuver on intraoperative hemodynamics: A randomized controlled trial

Pneumoperitoneum and the Trendelenburg position during laparoscopic hysterectomy (LH) increase intra-abdominal and intrathoracic pressure, reducing lung compliance and predisposing patients to atelectasis. This study evaluated the effects of alveolar recruitment maneuver (RM) on intraoperative hemodynamics, lung compliance, and oxygenation.

Following ethics committee approval, 70 American Society of Anesthesiologists I-II patients scheduled for elective LH were enrolled prospectively. Standard anesthesia monitoring was supplemented with radial arterial cannulation to assess cardiac output via arterial waveform analysis. After anesthesia induction and tracheal intubation, patients were randomly divided into 2 groups: Group I (RM) and Group II (Control). Group I underwent multi-step RM twice intraoperatively. Hemodynamic parameters, arterial blood gases, and compliance measurements were recorded throughout surgery. Durations of surgery, anesthesia, and postanesthesia care unit stay were documented. Pulmonary complications were assessed on postoperative days 1 and 3.

Demographics and durations of anesthesia, surgery, and postanesthesia care unit stay were comparable between groups. Inotropic requirements and intraoperative fluid volumes were similar. Heart rate remained comparable; however, mean arterial pressure, cardiac index, and stroke volume index were significantly higher in Group I, while stroke volume variation, pulse pressure variation, and systemic vascular resistance index were significantly lower (P < .001). These hemodynamic changes were pronounced at peak RM pressure. Group I exhibited significantly higher dynamic lung compliance, PaO2, and PaO2/FiO2 ratios (P < .001). Overall, RM was associated with transient, hemodynamically tolerable changes alongside improved lung mechanics and oxygenation.

Alveolar RM improved intraoperative lung compliance and oxygenation during LH without causing clinically significant hemodynamic instability. Incorporating RM into intraoperative management of laparoscopic procedures appears beneficial. These hemodynamic changes were transient and were not associated with an increased vasopressor requirement or clinically relevant hemodynamic instability.