Effects of Recruitment Maneuver During Intraoperative Period

Study Overview
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Brief Summary
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The aim of this study is to observe the effect of respiratory recruitment maneuver on intraoperative ventilatory parameters and postoperative pulmonary complications in patients over 18 years scheduled for laparoscopic hysterectomy.

Detailed Description
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In patients over 18 years who are scheduled for laparoscopic hysterectomy volunteering to participate in our study will receive anesthesia induction with one of our standard general anesthesia protocols. After intubation recruitment maneuver will be applied to the study group. General anesthesia and mechanical ventilation will be continued and completed according to our standard practice without any further intervention. Throughout the intraoperative period respiratory and haemodynamic parameters including compliance, airway resistance, mean arterial pressure, heart rate, pulse oxymetry, blood gas analysis, the applied inhalational anesthetic agent, minimum alveolar concentration, expiratory agent concentration and total agent consumption will be recorded. At the end of the operation anesthesia will be terminated and patients will be transferred to postanesthesia care unit (recovery unit after recovery and further discharged from to the ward when their Aldrete score is >8. The patients will be examined for respiratory complications on postoperative day 1, and will be followed up by telephone on day 5.

Official Title
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Effects of Recruitment Maneuver on Perioperative Pulmonary Complications in Hysterectomies

Conditions
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Laparoscopic Hysterectomy

Intervention / Treatment
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* Procedure: Alveolar Recruitment maneuver (ARM) +PEEP
* Procedure: PEEP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiology (ASA) I-II > 18 y laparoscopic hysterectomy patients Exclusion Criteria: Patient refusal to participate in the study <18 y, BMI> 40 Patients receiving invasive MV support in the last 1 month Patients who received chemotherapy or radiotherapy in the last 2 months Patients with severe pulmonary disease (COPD, asthma, pulm infection, bronchiectasis) (those who have previously received Non-Invasive MV, oxygen therapy or steroid therapy for an acute attack) Those with known severe pulmonary Hypertension Intracranial tm Hemodynamic instability Shock. Neuromuscular disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group 1, Alveolar Recruitment Maneuver+positive end expiratory pressure (PEEP) Group 2, PEEP
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Recruitment<br>Patients classified to receive recruitment maneuver + 5 mmHg positive end-expiratory pressure after anesthesia induction and intubation. | Procedure: Alveolar Recruitment maneuver (ARM) +PEEP<br>* Following anesthesia induction and intubation, alveolar recruitment maneuver followed by 5 mmHg PEEP<br>|
| Experimental: Non-recruitment<br>Patients classified to receive only 5 mmHg positive end-expiratory pressure after anesthesia induction and intubation. | Procedure: PEEP<br>* Following anesthesia induction and intubation, only 5 mmHg PEEP<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| measurement of change in airway compliance | the patients airway compliance will be monitorised as milliliter / centimeter of water (mL/cmH2O) continuously by the anesthesia machine and will be recorded intermittently. | T1:1minute(min)after intubationT2:5 min after Mechanical Ventilation(MV),T3:5 min after pneumoperitoneum,T4:3 min after Trendelenburg position(TP),T5:10 min after TP T6:20 min after TP T7:10 min after pneumoperitoneum deflation T8:1 min before extubation | 
| measurement of change in Airway resistance | the patients airway compliance will be monitorised as centimeter of water/ liter/ minute (cmH2O/L/min) continuously by the anesthesia machine and will be recorded intermittently. | T1:1 minute after intubationT2:5 min after MV T3:5 minute after pneumoperitoneum T4:3 minute after Trendelenburg position (TP) T5:10 minutes after TP T6:20 minutes after TP T7:10 minutes after pneumoperitoneum deflation T8:1 minute before extubation | 
| measurement of change in partial oxygen pressure (PaO2) | Arterial blood samples will be obtained and analysed. PaO2 will be recorded from these samples. | T1:1 minute after intubation T7: 10 minute after pneumoperitoneum deflation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of Postoperative respiratory distress, cough, phlegm | Pulmonary complications including respiratory distress, cough, phlegm will be evaluated by questionnaire and recorded. | T9: 24 hours after surgery . T10: on postoperative day 5 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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recruitment, pulmonary complication, oxygenisation