The effect of recruitment maneuver on static lung compliance in patients undergoing general anesthesia for laporoscopic cholecystectomy

[N. M. Anđelić]

106 listova

Ciljevi istraživanja: Cilj studije bio je da ispita da li primena alveolarnog rekrutman manevra (RM) tokom anestezije za laparoskopsku holecistektomiju (LH) dovodi do porasta statičke plućne komplijanse (Cstat), parcijalnog pritiska kiseonika u arterijskoj krvi (PaO2) i da li utiče na srčanu frekvencu (HR) i srednji arterijski pritisak (MAP) Metodologija: Istraživanje je sprovedeno kao klinička prospektivna studija intervencije. Pacijente smo podelili u dve grupe prema indeksu telesne mase: normalno uhranjeni (grupa I) i predgojazni i gojazni klase I (grupa II). Pratili smo promene Cstat, PaO2, HR i MAP u 6 vremenskih tačaka: T1 (uvod u anesteziju), T2 (formiranje pneumoperitoneuma), T3 (RM sa PEEP-om od 5 cm H2O), T4 (RM sa PEEP-om 7), T5 (desuflacija) i T6 (RM na kraju operacije). RM smo izvodili malim porastom vršnog pritiska za +5 cm H2O uz inverziju odnosa inspirijuma i ekspirijuma na 1:1 i primenom PEEP-a od 5 i 7 cmH2O. Rezultati: Od ukupno 96 pacijenata, 33 su pripadala grupi I, a 63 grupi II. Do porasta vrednosti Cstat došlo je nakon sva tri RM. U svakoj vremenskoj tački merenja, vrednost Cstat je viša kod normalno uhranjenih. Nakon drugog i trećeg RM značajniji porast Cstat se desio u grupi II. Na kraju operacije, u odnosu na vrednosti nakon uvoda u anesteziju, u obe grupe su zabeležene više vrednosti Cstat. Porast PaO2, nakon primene RM, je zabeležen kod obe grupe, bez klinički značajnih promena u HR i MAP. Zaključak: Tokom LH primena RM dovodi do značajnog povećanja Cstat i poboljšanja gasne razmene. Prevenciju atelektaza tokom anestezije treba započeti odmah nakon uvoda u anesteziju, protektivnim merama ventilacije, malim disajnim volumenima, umerenih vrednosti PEEP-a uz povremenu primenu RM.

Background and Objectives: The aim of this study was to examine whether the use of an alveolar recruitment maneuver (RM) leads to a significant increase in static lung compliance (Cstat) and an improvement in gas exchange in patients undergoing laparoscopic cholecystectomy. Methodology: A clinical prospective intervention study was conducted. Patients were divided into two groups according to their body mass index: normal-weight (group I) and pre-obese and obese grade I (group II). We monitored lung mechanics (static lung compliance (Cstat)), alongside gas exchange and hemodynamic changes (heart rate - HR, mean arterial pressure - MAP) at six time points: T1 (induction of anesthesia), T2 (formation of pneumoperitoneum), T3 (RM with a PEEP of 5 cm H2O), T4 (RM with a PEEP of 7 cm H2O), T5 (desufflation), and T6 (RM at the end). The RM was performed by increasing the peak pressure by +5 cm of H2O at an equal inspiration-to-expiration ratio (I/E = 1:1) and applying a PEEP of 5 and 7 cm of H2O. Results: Out of 96 patients, 33 belonged to group I and 63 to group II. An increase in Cstat values occurred after all three RMs. Cstat value was measured higher in group I than in group II. A higher increase in Cstat was observed in group II after the second and third RM. Cstat values were higher at the end of the surgical procedure compared to values after the induction of anesthesia. The RM led to a significant increase in PaO2 in both groups without changes in HR or MAP. Conclusion: During laparoscopic cholecystectomy, the application of RM leads to an increase in Cstat and an improvement in gas exchange. The prevention of atelectasis during anesthesia should be initiated immediately after the induction of anesthesia, using protective mechanical ventilation and RM.

laparoskopska holecistektomija; alveolarni rekrutman manevar; statička plućna kompliansa

laparoscopic cholecystectomy; alveolar recruitment maneuver; static lung compliance

616‑089.5(043.3)

hirurgija

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