Introduction: Laparoscopic surgery has become an increasingly preferred method due to the small sizeof the abdominal incision line, causing less tissue trauma, reduced post-operative analgesic requirement,providing early mobilization, decreased post-operative ileus, and shortened hospital stay. However, pneu moperitoneum may cause upward displacement of the diaphragm by increasing intra-abdominal pressure,decrease functional residual capacity and lung compliance, and develop atelectasis. The aim of this study isto investigate the effect of recruitment maneuver and positive end expiratory pressure (PEEP) applicationsperformed together with graduated pressure levels and low O2concentration on respiratory mechanics, oxy genation, and hemodynamic parameters in patients who underwent laparoscopic cholecystectomy. Materials and Methods: Sixty patients with laparoscopic surgery and ASA I and II were divided into three groups(n=20 in each group). Recruitment maneuvers were performed in the patients in Group R with a stepwise methodtwice, 5 min after insufflation and desufflation. While the patients were at 8 cmH2 O PEEP value, they were ven tilated 10 times with 5 cmH2 O < PEEP increments while the Ppeak<50 cmH2 O up to 20 cmH2 O PEEP value.The gradually increased PEEP value was reduced again gradually and terminated at the initial PEEP value of 8cmH2 O. In the patients in Group P, only 8 cmH2 O PEEP was initiated after intubation and recruitment maneuverwas not performed. On the other hand, PEEP was not initiated and recruitment maneuver was not performed inthe patients in Group C after intubation. In all patients, 5 min after insufflation and desufflation, intraoperativearterial blood gas analysis was performed twice, and simultaneous static and dynamic compliance values andhemodynamic values (systolic, diastolic, mean arterial pressure, and heart rate) were recorded. Results: PaO2values 5 min after insufflation and desufflation in Group C (insufflation: 156.65±43.21 and desuf flation: 165.45±35.83) were detected significantly lower than Group R (insufflation: 199.50±29.32 and desuf flation: 253.33±37.93) and Group P (insufflation: 200.93±58.16 and desufflation: 202.84±47.13) (p<0.05). PaO2 measurements 5 min after desufflation in the cases in the R group were found to be significantly higher thanthe cases in Group P (p<0.05). In the cases in Group R, the increase in the PaO2value 5 min after desufflationwas significantly higher to the PaO2value 5 min after insufflation (p<0.05). The change in PaO2values in thecases in Group P and Group K was not statistically significant (p>0.05). Compliance measurements of thecases in Group R 5 min after desuflation were found to be significantly higher than the cases in Groups P and C. Conclusion: It is thought that recruitment maneuver and PEEP application with gradually increasing pres sure in patients undergoing laparoscopic surgery have positive effects on oxygenation, increases lung com pliance and can be used safel ">
[PDF] Effect of pressure-controlled recruitment maneuver onhemodynamics and respiratory mechanics during pneumoperitoneum | [PDF] Effect of pressure-controlled recruitment maneuver onhemodynamics and respiratory mechanics during pneumoperitoneum
Introduction: Laparoscopic surgery has become an increasingly preferred method due to the small sizeof the abdominal incision line, causing less tissue trauma, reduced post-operative analgesic requirement,providing early mobilization, decreased post-operative ileus, and shortened hospital stay. However, pneu moperitoneum may cause upward displacement of the diaphragm by increasing intra-abdominal pressure,decrease functional residual capacity and lung compliance, and develop atelectasis. The aim of this study isto investigate the effect of recruitment maneuver and positive end expiratory pressure (PEEP) applicationsperformed together with graduated pressure levels and low O2concentration on respiratory mechanics, oxy genation, and hemodynamic parameters in patients who underwent laparoscopic cholecystectomy. Materials and Methods: Sixty patients with laparoscopic surgery and ASA I and II were divided into three groups(n=20 in each group). Recruitment maneuvers were performed in the patients in Group R with a stepwise methodtwice, 5 min after insufflation and desufflation. While the patients were at 8 cmH2 O PEEP value, they were ven tilated 10 times with 5 cmH2 O < PEEP increments while the Ppeak<50 cmH2 O up to 20 cmH2 O PEEP value.The gradually increased PEEP value was reduced again gradually and terminated at the initial PEEP value of 8cmH2 O. In the patients in Group P, only 8 cmH2 O PEEP was initiated after intubation and recruitment maneuverwas not performed. On the other hand, PEEP was not initiated and recruitment maneuver was not performed inthe patients in Group C after intubation. In all patients, 5 min after insufflation and desufflation, intraoperativearterial blood gas analysis was performed twice, and simultaneous static and dynamic compliance values andhemodynamic values (systolic, diastolic, mean arterial pressure, and heart rate) were recorded. Results: PaO2values 5 min after insufflation and desufflation in Group C (insufflation: 156.65±43.21 and desuf flation: 165.45±35.83) were detected significantly lower than Group R (insufflation: 199.50±29.32 and desuf flation: 253.33±37.93) and Group P (insufflation: 200.93±58.16 and desufflation: 202.84±47.13) (p<0.05). PaO2 measurements 5 min after desufflation in the cases in the R group were found to be significantly higher thanthe cases in Group P (p<0.05). In the cases in Group R, the increase in the PaO2value 5 min after desufflationwas significantly higher to the PaO2value 5 min after insufflation (p<0.05). The change in PaO2values in thecases in Group P and Group K was not statistically significant (p>0.05). Compliance measurements of thecases in Group R 5 min after desuflation were found to be significantly higher than the cases in Groups P and C. Conclusion: It is thought that recruitment maneuver and PEEP application with gradually increasing pres sure in patients undergoing laparoscopic surgery have positive effects on oxygenation, increases lung com pliance and can be used safel ">
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