Objective:

The effects of different ventilatory strategies on respiratory mechanics and hemodynamics in laparoscopic cholecystectomies were investigated.

Material and Methods:

Fifty-one patients scheduled for laparoscopic cholecystectomy were allocated to the study and divided into three groups (Group K, n:17; Group P, n:17; Group R, n:17). Basal ventilation was adjusted as 8 mL kg-1 tidal volume, 10 breaths min-1 and I: E: 1: 2. After intubation, Group K received ZEEP, Group P 5 cmH2 O PEEP, Group R 5 cmH2 O PEEP with recruitment maneuver 5 min after CO2 insufflation and desufflation. In maneuver, PEEP was rised to 10-15-20 cmH2 O, and patients were ventilated for 10 breaths. Blood pressure, heart rate, SpO2 , FiO2 , ETCO2 , airway pressure, static and dynamic compliance and blood gas values were monitored.

Results:

PaO2 was found to be higher after recruitment maneuver in Group R (p<0.05). The elevation in PaO2 that continued for the first hour approached to basal values at 6. hours. Intraoperative PaO2 /FiO2 ratios were also high in Group R (p<0.05). In all groups, peak and plateau pressures were observed to rise, static and dynamic compliance to decrease after CO2 insufflation. Compliance values were found to be higher during the operation in Group R after the first maneuver (p<0.05). Arterial pressures were lower in Group R at all times of measurement while heart rates were similar. The difference was statistically significant after the first maneuver (p=0.007).

Conclusion:

Recruitment maneuver applied by controlled PEEP increase, followed by ventilation with 5 cmH2 O PEEP was shown to improve oxygenation without causing any hemodynamic side effect.

Keywords: General anesthesia, laparoscopic cholecystectomy, recruitment, PEEP