Safety and Effectiveness of Alveolar Recruitment Maneuvers and Positive End-expiratory Pressure During General Anesthesia for Cesarean Section: A Prospective, Randomized Trial

Abstract

(Int J Obstet Anesth. 2017;30:30–38) General anesthesia (GA) is sometimes associated with impaired oxygenation. Changes in respiratory mechanics and lung function under anesthesia contribute to this, with atelectasis being one of the most common etiologies of decreased oxygenation during GA. The supine position required during cesarean delivery results in decreased functional residual capacity and impaired lung compliance, as does the gravid uterus. Therefore, this patient population may be more likely to develop clinically significant atelectasis during general anesthesia. Alveolar recruitment maneuvers (ARM) with positive end-expiratory pressure (PEEP) along with low tidal volumes, considered a lung-protective ventilation strategy, can improve lung function and oxygenation and are frequently used for critically ill patients with respiratory distress syndrome. ARM with PEEP has also been shown to improve oxygenation and lung compliance in patients during general anesthesia. The current study was undertaken to test the hypothesis that ARM with PEEP and low tidal volume could improve intraoperative lung dynamic compliance during GA for cesarean delivery.