Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

The effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study

Prabakaran Parmeswaran, Priyanka Gupta, Amanta L. Ittoop, Ashutosh Kaushal, Ajit Kumar, Deepak Singla

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: Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH.

: Sixty-six, ASA I‒II, female patients, scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6–8−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cm of H2O. Patients in group R received recruitment maneuvers of 30 cm H2O, every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored.

: Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p = 0.55).

: This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values, however, it led to improved oxygenation intraoperatively.


Robot-assisted surgery;  Hysterectomy;  Blood oxygen levels;  Pulmonary atelectasis;  Mechanical ventilation


1 MA Borahay, OL Tapisiz, I Alanbay, GS. Kilic Outcomes of robotic, laparoscopic, open hysterectomy for benign conditions in obese patients J Turk Ger Gynecol Assoc, 19 (2018), pp. 72-77

2 J Canet, L Gallart, C Gomar, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort Anesthesiology, 113 (2010), pp. 1338-1350

3 HH Bendixen, J Hedley-Whyte, MB. Laver Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: a concept of atelectasis N Engl J Med, 269 (1963), pp. 991-996

4 M Duggan, BP. Kavanagh Pulmonary atelectasis: a pathogenic perioperative entity Anesthesiology, 102 (2005), pp. 838-854

5 LD Egbert, MB Laver Bendixen HH. Intermittent deep breaths and compliance during anesthesia in man Anesthesiology, 24 (1962), pp. 57-60

6 NM Goldenberg, BE Steinberg, WL Lee, DN Wijeysundera, BP. Kavanagh Lung-protective ventilation in the operating room: time to implement? Anesthesiology, 121 (2014), pp. 184-188

7 E-S Choi, A-Y Oh, C-B In, J-H Ryu, Y-T Jeon, H-G Kim Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic-assisted radical prostatectomy: A randomized single-blinded trial PLoS ONE, 12 (2017),  e0183311

8 Lee Jeong Anesthetic considerations for robotic surgery Korean J Anesthesiol, 66 (2014), pp. 3-11

9 S. Baltayian A brief review: anesthesia for robotic prostatectomy J Robotic Surg, 2 (2008), pp. 59-66

10 DR Hess, LM. Bigatello Lung recruitment: the role of recruitment maneuvers Respir Care, 47 (2002), pp. 308-317

11 T Dyhr, N Laursen, A. Larsson Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery Acta Anaesthesiol Scand, 46 (2002), pp. 717-725

12 E Futier, J-M Constantin, CP Burtz, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery N Engl J Med, 369 (2013), pp. 428-437

13 FX Whalen, O Gajic, GB Thompson, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery Anesth Analg, 102 (2006), pp. 298-305

14 TN Weingarten, FX Whalen, DO Warner, et al. Comparison of two ventilator strategies in elderly subjects undergoing major abdominal surgery Br J Anaesth, 104 (2010), pp. 16-22

15 J Sprung, FX Whalen, T Comfere, et al. Alveolar recruitment and arterial desflurane concentration during bariatric surgery Anesth Anal, 108 (2009), pp. 120-127

16 PJ Hantzidiamantis, Amaro E. Physiology Alveolar to Arterial Oxygen Gradient (Aa Gradient) StatPearls [Internet], StatPearls Publishing, Treasure Island (FL) (2019)

17 C Ferrando, M Soro, C Unzueta, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomized controlled trial Lancet Resp Med, 6 (2018), pp. 193-203

18 Writing Committee for the PROBESE Collaborative Group of the PROtectiveVEntilation Network (PROVEnet) for the Clinical Trial Network of the European Society of Anaesthesiology. Effect of intraoperative high Positive End-Expiratory Pressure (PEEP) with recruitment maneuvers vs. low PEEP on postoperative pulmonary complications in obese patients: a randomized clinical trial JAMA, 321 (2019), pp. 2292-2305

19 SN Hemmes, M Gama de Abreu, P Pelosi, MJ. Schultz High versus low positive end-expiratory pressure during general anesthesia for open abdominal surgery (PROVHILO trial): a multicentrerandomized controlled trial Lancet, 384 (2014), pp. 495-503

20 P Severgnini, G Selmo, C Lanza, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function Anesthesiology, 118 (2013), pp. 1307-1321

21 MI Monge García, AG Cano, MG Romero, JCD Monrové Respiratory and hemodynamic changes during lung recruitment maneuvering through progressive increases and decreases in PEEP level Med Intensiva, 36 (2012), pp. 77-88

22 Y. Cui, R. Cao, Y. Wang, G. Li Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis Respiration, 99 (3) (2020), pp. 1-13

23 JM. Cairo Improving Oxygenation and Management of Acute Respiratory Distress Syndrome (6th Edi), Pilbeam's Mechanical Ventilation, 13, Elsevier (2016), pp. 239-279

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