THE EFFECT OF ALVEOLAR RECRUITMENT MANOEUVRE ON INTRAOPERATIVE HAEMODYNAMICS

During laparoscopic hysterectomy, pneumoperitoneum is created with carbon dioxide (CO₂) to provide surgical field of view and the patient is placed in Trendelenburg position. This increases intrathoracic pressure, decreases lung compliance and increases the risk of atelectasis. Therefore, lung protective ventilation strategies such as alveolar recruitment manoeuvre (RM), individualised PEEP application and low tidal volume are recommended. RM aims to increase lung compliance and prevent atelectasis by reopening collapsed alveoli. However, changes in haemodynamic parameters, especially mean arterial pressure and cardiac output, may occur during RM. In addition to standard monitoring for the management of these changes, haemodynamic evaluation can be performed with minimally invasive methods such as arterial waveform analysis. In this study, we aimed to evaluate the effects of RM applied during laparoscopic hysterectomy on intraoperative haemodynamic parameters using arterial waveform analysis.

Inclusion criteria

• ASA Class 1-2 patients 18-70 years old

Exclusion criteria

• <18 y, BMI>40
• Patients receiving invasive mechanical ventilator support in the last 1 month
• Patients who have received chemotherapy or radiotherapy in the last 2 months
• Those with severe lung disease (COPD, asthma, pulmonary infection, bronchiectasis, previous need for non-invasive mechanical ventilation, oxygen therapy or steroid therapy for acute attack)
• Known severe pulmonary hypertension
• Patient refusal to participate in the study
• Intracranial tumour
• Haemodynamic instability
• Shock
• Neuromuscular disease
• Pathologies causing increased intracranial and intraocular pressure
• Atrial fibrillation