Library of the School of Health Sciences
ΠΜΣ Αναπνευστική Ανεπάρκεια και Μηχανικός Αερισμός

2024-02-21

2024

Griva Panagiota

Νικολέττα Ροβίνα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Ντάγανου, Εξωτερική Συνεργάτης Ιατρική Σχολή, ΕΚΠΑ
Βασιλική Χαντζιάρα, Εξωτερική Συνεργάτης Ιατρική Σχολή, ΕΚΠΑ

Αποκατάσταση της ενδοτικότητας του πνεύμονα μετά από έναν χειρισμό επιστράτευσης κυψελίδων σε λαπαροσκοπικά γυναικολογικά χειρουργεία

Greek

Restoration of pulmonary compliance after laparoscopic gynecologic surgery using a recruitment maneuver

Introduction: In recent years, laparoscopic surgery is the method of choice concerning the surgical treatment of many gynaecological diseases. Pneumoperitoneum and Trendelenburg position reduce lung compliance causing postoperative respiratory complications. Alveolar recruitment manoeuvres “open” the collapsed alveoli restoring compliance and improving gas exchange.
Aim of the study: The purpose of this research is to investigate the hypothesis that an alveolar recruitment manoeuvre can restore lung compliance to initial values after a laparoscopic gynaecological surgery.
Material and Method: In this studied, 31 patients who underwent laparoscopic gynaecological surgery were enrolled. Protective mechanical ventilation was applied (Vt = 6 ml/kg of ideal body weight and positive end expiratory pressure (PEEP) = 6-8 cm H20). The radial artery was catheterized in all patients. An alveolar recruitment manoeuvre (incremental and decremental positive end-expiratory pressure) was applied ten minutes after release of the pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at 8 different time plots: after induction of anaesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 minutes after insufflation of carbon dioxide (T4 and T5), in the supine position (T7), after desufflation (T7) and 10 minutes after an alveolar recruitment manoeuvre at the end of surgery (T8).
Results: After induction to anaesthesia (T1) the mean value of lung compliance was 58.2 mL/cmH2O. Pneumoperitoneum and Trendelenburg position caused a decrease in compliance by 18.21% (T7 vs T1; P < 0.05) compared to baseline. After the alveolar recruitment manoeuvre, compliance increased by 22% compared with the mean value of compliance at time T1 (T8 vs. T1; P < 0.05).
Conclusions: Lung compliance does not return to initial values after performing laparoscopic gynaecological procedures. However, after the release of the pneumoperitoneum, an alveolar recruitment manoeuvre is beneficial as it improves compliance and gas exchange.

Health Sciences

Pulmonary compliance, Alveolar recruitment manoeuvre, Laparoscopic procedures, Gas exchange, Pneumoperitoneum, Trendelenburg position

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https://pergamos.lib.uoa.gr/uoa/dl/object/3389744