The Effect of an Alveolar Recruitment Strategy on Oxygenation during Laparascopic Cholecystectomy

Abstract

This prospective randomized controlled trial examined the effect of an “alveolar recruitment strategy” (ARS) in healthy patients having laparoscopic cholecystectomy. Twenty-four consecutive ASA 1 or 2 patients were randomly allocated to an ARS or control group. All patients were manually ventilated to a maximal airway pressure of 25 to 30 cmH 2 O or a tidal volume of 10 ml/kg during induction of general anaesthesia. After intubation, the control group was ventilated with standardized mechanical ventilation settings. The ARS group was manually ventilated to an airway pressure of 40 cmH 2 O for 10 breaths over one minute, followed by mechanical ventilation with similar standardized settings plus 5 cmH 2 0 positive end-expiratory pressure. Blood pressure, heart rate, arterial oxygen and carbon dioxide tension (PaO 2 and PaCO 2 ) was measured pre-induction, 20 minutes post induction but before abdominal insufflation, 20 minutes after abdominal insufflation, and 20 minutes after arrival in the recovery room. Demographic and operation data were similar. The ARS group pre-insufflation PaO 2 [30.16 (9.43)] was higher than the control group [22.19 (9.08)] (P=0.047). There was a significant difference in PaO 2 between the ARS [23.94 (4.87)] and control [17.26 (3.93)] groups during the post-insufflation period (P=0.001). There were no significant differences in PaO 2 between the groups during baseline and recovery periods. No adverse effects were reported. ARS improved arterial oxygenation intraoperatively in healthy patients having laparoscopic cholecystectomy, without clinical cardiovascular compromise or respiratory complication. We conclude that this alveolar recruitment strategy is a useful method of increasing arterial oxygenation.