The effects of 'recruitment' maneuver on laparoscopic colon surgery

Objective: During general anesthesia and iatrogenic pneumoperitoneum practice, some factors resulting in formation of atelectasia such as increased intra-abdominal pressure, decreased functional residual capacity and lung compliance can affect the respiratory system therefore due to the oxygenation and arterial blood gas parameters. "Recruitment" maneuver may be effective in prevention of atelectesia and improvement of oxygenation. The aim of this study is observing the effect of recruitment maneuver on ventilation mechanics and oxygenation. Material and Methods: In this study 32 adult candidates for laparoscopic colon surgery were observed under standard anesthesia. After induction, to create pneumoperitoneum with CO2 flow, the insuflator was set at the rate of 2 L/min. During the procedure the intra-abdominal pressure was kept constant at 12mm-Hg. The subjects randomly were divided into two groups. In recruitment group (Group Recruitment, n=16) we stopped ventilation after desuflation and applied 45 cm H2O CPAP for 15 seconds and then following 45 seconds of ventilation we repeated the maneuver. In control group (Group Control, n=16) only mechanic ventilation but nothing else was applied. For assessment of ventilation mechanics, the dynamic compliance (Cdyn) was measured; just 10 minutes after intubation in supine position (induction, 1), 10 minutes after creating pneumoperitoneum (insuflation-horizontal, 2), 10 minutes after putting the patient into Fowler position at 30 degrees (Fowler, 3), just before desuflation at 30 degrees Trendelenburg position (Trendelenburg, 4) and after desuflation at supine position (desuflation- horizontal, 5). Simultaneous arterial blood gas analysis was performed at first, second and fifth measurements. Results: Cdyn measurements at different positions were similar when two groups were compared to each other. The lowest value was measured at Trendelenburg position. It was detected as 29.2 +/- 6.3 in recruitment group and 27.8 +/- 8.2 in control group. Partial oxygen pressure values were better in recruitment group. The partial oxygen pressure measurements were 227.3 +/- 77.4, 180.5 +/- 74.4, 192.5 +/- 39.8 mm-Hg at 1st, 2nd and 5th measurements respectively for control group while they were 228.9 +/- 77.5, 222.6 +/- 63.6 and 218.5 +/- 48.7 mm Hg for recruitment group. Conclusion: We can suggest that the recruitment maneuver is effective for better oxygenation in laparoscopic colon surgery/interventions.