Evaluation of effect of lung recruitment manoeuvres on perioperative atelectasis in laproscopic cholecystectomies: a randomised controlled trial.

Abstract

BACKGROUND: Approximately 90% of patients undergoing general anesthesia encounter atelectasis, especially after laparoscopic cholecystectomy. Pneumoperitoneum during laparoscopic surgeries significantly hinders pulmonary function, leading to notable atelectasis. The lung recruitment maneuver may mitigate hypoxia caused by atelectasis and minimize postoperative pulmonary complications.

METHODS: Patient selection was randomized; Group UC did not receive lung recruitment, while Group URM did. All patients underwent ultrasonography at four time points: T1 - just before anaesthesia induction, T2 - post-surgery, T3 - 15 minutes post-extubation, and T4 - 30 minutes post-extubation. Only participants from the URM group received lung recruitment, which was guided by real-time ultrasound. Ultrasonic scanning indicated the absence of collapsed areas following manual adjustment of airway pressure from 10 cmH2O to 20 cmH2O, with a FiO2 of 0.4. Every patient received lung ultrasonography at 15 (T3) and 30 (T4) minutes following extubation to evaluate persistent atelectrauma and desaturation.

CONCLUSION: At T3 and T4, the URM group exhibited a significantly reduced aeration loss of 22% and 51%, respectively, when compared to the UC group, which showed losses of 53% and 87% (p < 0.01). The URM group exhibited better oxygenation post-surgery compared to the UC group, with mean SpO₂ values of 98.10 ± 1.744% versus 94.54 ± 1.286% (p = 0.001). The increased alveolar recruitment and gas exchange in the URM group accounted for this outcome. In conclusion, the utilization of ultrasound for facilitating lung recruitment techniques may decrease atelectasis during surgeries, improve oxygenation, and result in enhanced pulmonary outcomes in laparoscopic cholecystectomy.