ASA Class I/II Patients Scheduled for Surgery Under General Anesthesia, Laparoscopic Hysterectomy
Conditions
Keywords
lung protective ventilation, recruitment manoeuvre, laparoscopic surgery, haemodynamic changes
Brief summary
Alveolar recruitment manoeuvre plays a key role in the prevention of atelectasis. In addition, it affects haemodynamic parameters. This study aims to investigate the effects of RM on haemodynamic parameters using minimally invasive monitoring techniques.
Detailed description
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.
Interventions
None listed
Sponsors
Balikesir University
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 70 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of RM on cardiac power index(CPI) | intraoperatively | cardiac power index(CPI) measurement via arterial line as ml/min/m2 |
| Effect of RM on stroke volume index(SVI) | intraoperatively | SVI measurement via arterial cannula as L/min/m2 |
| Effect of RM on pulse pressure variablity(PPV) | intraoperatively | pulse pressure variability measured by finger probe as cm/s |
| Effect of RM on systemic vascular resistance index(SVRI) | intraoperatively | systemic vascular resistance index(SVRI) measurement via arterial cannula as L/min/m2 |
| Effect of RM on heart rate (in bpm) | perioperatively | measurement of heart rate in bpm |
| Effect of RM on pressure mmHg | perioperatively | blood pressure measurement in mmmercury |
| Effect of RM on Cardiac index(CI) | intraoperatively | Cardiac Index measurement via an arterial cannula as l/min/m2 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pulmonary comlications (infection, bronchospasm, pleural effusion, atelectasis, respiratory failure) | postoperative day 1 and 3 | assessment of pulmonary complications |
| Effect of RM on Compliance | intraoperatively | measurement of dynamic compliance by Ventilator as Cdyn |
| Effect of RM on Oxygenation | İntraoperatively | measurement of oxygenation via obtaining partial blood oxygene pressure via arterial blood sample pulse oxymeter as % |
Countries
Turkey (Türkiye)
Outcome results
None listed