scholarly journals The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0217405 ◽  
Author(s):  
Yu Cui ◽  
Rong Cao ◽  
Gen Li ◽  
Tianqing Gong ◽  
Yingyu Ou ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Lung Recruitment ◽  
Recruitment Maneuvers

scholarly journals The Effect of Ultrasound-Guided Lung Recruitment Maneuvers On Atelectasis In Lung-Healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Yi Liu ◽  
Jingyu Wang ◽  
Yong Wan ◽  
Yuan Geng ◽  
Yiran Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Recruitment ◽  
Gynecologic Surgery ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided ◽  
Recruitment Maneuvers ◽  
Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration: (prospectively registered): ChiCTR2000033529. Registered on 6/4/2020.

scholarly journals Effect of Ultrasound-guided Lung Recruitment Maneuvers on Atelectasis in Lung-healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Yi Liu ◽  
Jingyu Wang ◽  
Yong Wan ◽  
Yuan Geng ◽  
Yiran Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Recruitment ◽  
Gynecologic Surgery ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided ◽  
Recruitment Maneuvers ◽  
Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration (prospectively registered)ChiCTR2000033529. Registered on June 4, 2020.

Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis

Respiration ◽  
2019 ◽  
Vol 99 (3) ◽  
pp. 264-276 ◽  
Author(s):  
Yu Cui ◽  
Rong Cao ◽  
Yu Wang ◽  
Gen Li
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Lung Recruitment ◽  
Recruitment Maneuvers

scholarly journals The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 583 ◽  
Author(s):  
Chang-Hoon Koo ◽  
Eun Young Park ◽  
Sun Young Lee ◽  
Jung-Hee Ryu
Keyword(s):  
Randomized Controlled Trials ◽  
General Anesthesia ◽  
Oxygen Concentration ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Controlled Trials ◽  
Postoperative Pulmonary Complications ◽  
Randomized Controlled ◽  
Oxygen Fraction ◽  
Inspired Oxygen

High intraoperative inspired oxygen concentration is applied to prevent desaturation during induction and recovery of anesthesia. However, high oxygen concentration may lead to postoperative pulmonary complications. The purpose of this study is to compare the postoperative pulmonary parameters according to intraoperative inspired oxygen fraction in patients undergoing general anesthesia. We identified all randomized controlled trials investigating postoperative differences in arterial gas exchange according to intraoperative fraction of inspired oxygen (FiO2). A total of 10 randomized controlled trials were included, and 787 patients were analyzed. Postoperative PaO2 was lower in the high FiO2 group compared with the low FiO2 group (mean difference (MD) −4.97 mmHg, 95% CI −8.21 to −1.72, p = 0.003). Postoperative alveolar-arterial oxygen gradient (AaDO2) was higher (MD 3.42 mmHg, 95% CI 0.95 to 5.89, p = 0.007) and the extent of atelectasis was more severe (MD 2.04%, 95% CI 0.14 to 3.94, p = 0.04) in high intraoperative FiO2 group compared with low FiO2 group. However, postoperative SpO2 was comparable between the two groups. The results of this meta-analysis suggest that high inspired oxygen fraction during anesthesia may impair postoperative pulmonary parameters. Cautious approach in intraoperative inspired oxygen fraction is required for patients susceptible to postoperative pulmonary complications.

Maternal and Neonatal Effect of Fentanyl as a Premedication before Induction of General Anesthesia in Cesarean Surgery: A Systematic Review and Meta-analysis of Randomized Clinical Trials

2019 ◽  
Vol 15 (4) ◽  
pp. 232-237
Author(s):  
Mir Hadi Musavi ◽  
Behzad Jodeiri ◽  
Keyvan Mirnia ◽  
Morteza Ghojazadeh ◽  
Zeinab Nikniaz
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Apgar Score ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Intravenous Fentanyl ◽  
Neonatal Effect ◽  
Fentanyl Group

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: - 0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were significantly lower compared with placebo group. Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

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