The effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study
Efeito da manobra de recrutamento alveolar intraoperatório na oxigenação intraoperatória e nos testes de função pulmonar pós-operatória em pacientes submetidas à histerectomia assistida por robótica: um estudo randomizado simples-cego
Prabakaran Parmeswaran, Priyanka Gupta, Amanta L. Ittoop, Ashutosh Kaushal, Ajit Kumar, Deepak Singla
Abstract
Background
Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH.
Methods
Sixty-six, ASA I‒II, female patients, scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6–8 mL.kg−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cm of H2O. Patients in group R received recruitment maneuvers of 30 cm H2O, every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored.
Results
Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p = 0.55).
Conclusion
This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values, however, it led to improved oxygenation intraoperatively.
Keywords
Resumo
Introdução
As histerectomias robóticas (HR) requerem posicionamento de Trendelenburg e pneumoperitônio, o que acentua ainda mais a alteração da mecânica respiratória induzida pela anestesia geral. O papel da Manobra de Recrutamento (MR) como estratégia de proteção pulmonar durante as cirurgias intraoperatórias não foi muito estudado. Planejamos este estudo para avaliar o efeito da MR na oxigenação perioperatória e na espirometria pós-operatória usando PaO2/FiO2 e VEF1/CVF, respectivamente, em pacientes submetidos a HR.
Métodos
Sessenta e seis pacientes ASA I‒II do sexo feminino agendadas para HAR eletiva foram randomizadas em grupo R (manobra de recrutamento, n = 33) ou grupo C (controle, n = 33). A espirometria portátil foi realizada um dia antes da cirurgia. Os pacientes foram induzidos com anestesia geral e a ventilação mecânica iniciada com modo de controle de volume, com Volume Corrente (VC) de 6–8 mL.kg−1, Frequência Respiratória (FR) de 12 min, relação inspiração-expiração (relação I:E ) de 1:2, FiO2 de 0,4 e Pressão Expiratória Final Positiva (PEEP) de 5 cmH2O. Os pacientes do grupo R receberam manobras de recrutamento de 30 cmH2O a cada 30 minutos após a intubação traqueal. Os objetivos primários foram a comparação da oxigenação e ventilação entre os dois grupos no intraoperatório e a espirometria portátil no pós-operatório. As complicações pulmonares pós-operatórias, como dessaturação, edema pulmonar, pneumonia, foram monitoradas.
Resultados
Os pacientes que receberam RM apresentaram PaO2 (mmHg) significativamente maior (203,2+-24,3 vs. 167,8+-27,3, p < 0,001) em T2 (30 min após o pneumoperitônio). Entretanto, não houve diferença significativa na espirometria portátil entre os grupos no pós-operatório (CVF, 1,40 ± 0,5 L vs. 1,32 ± 0,46 L, p = 0,55).
Conclusão
Este estudo concluiu que o recrutamento intraoperatório não impediu a deterioração dos valores da espirometria pós-operatória; no entanto, levou a uma melhor oxigenação no intraoperatório.
Palavras-chave
References
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