Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1454-1464
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1454
Incidence, characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection
Nan-Rong Zhang, Zhi-Nan Zheng, Kai Wang, Hong Li
Nan-Rong Zhang, Zhi-Nan Zheng, Kai Wang, Hong Li, Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Kai Wang, Hong Li, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Li H contributed to study design; Zhang NR, Zheng ZN, and Wang K contributed to data collection; Li H, Zhang NR, and Wang K contributed to data analysis and manuscript preparation; and all authors contributed to manuscript review.
Supported by the Medical Scientific Research Foundation of Guangdong Province, No. A2017045.
Institutional review board statement: This study was reviewed and approved by the Institutional Ethical Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (approval No. 2017ZSLYEC-002).
Informed consent statement: Written informed consent was obtained from all the subjects before enrollment in the study.
Conflict-of-interest statement: The authors declare that there are no potential conflicts of interest with respect to the study, authorship, and/or publication of this article.
Data sharing statement: The data of this study can be obtained from the corresponding author Hong Li if reasonably requested.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Li, MD, Doctor, Researcher, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. lihong36@mail.sysu.edu.cn
Received: January 30, 2023
Peer-review started: January 30, 2023
First decision: April 20, 2023
Revised: May 9, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: July 27, 2023
Processing time: 172 Days and 3.6 Hours
Abstract
BACKGROUND

Alveolar recruitment maneuvers (ARMs) may lead to transient hypotension, but the clinical characteristics of this induced hypotension are poorly understood. We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.

AIM

To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.

METHODS

This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects. An ARM was repeated every 30 min during intraoperative mechanical ventilation. The primary endpoint was ARM-related hypotension, defined as a mean arterial pressure (MAP) < 60 mmHg during an ARM or within 5 min after an ARM. The risk factors for hypotension were identified. The peri-ARM changes in blood pressure were analyzed for the first three ARMs (ARM1,2,3) and the last ARM (ARMlast).

RESULTS

Thirty-four subjects (24.3%) developed ARM-related hypotension. Of all 1027 ARMs, 37 (3.61%) induced hypotension. More ARMs under nonpneumoperitoneum (33/349, 9.46%) than under pneumoperitoneum conditions (4/678, 0.59%) induced hypotension (P < 0.01). The incidence of hypotension was higher at ARM1 points than at non-ARM1 points (18/135, 13.3% vs 19/892, 2.1%; P < 0.01). The median percentage decrease in the MAP at ARM1 was 14%. Age ≥ 74 years, blood loss ≥ 150 mL and peak inspiratory pressure under pneumoperitoneum < 24 cm H2O were risk factors for ARM-related hypotension.

CONCLUSION

When the ARM was repeated intraoperatively, a quarter of subjects developed ARM-related hypotension, but only 3.61% of ARMs induced hypotension. ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state, and in elderly subjects. Fortunately, ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.

Keywords: Alveolar recruitment maneuvers; Hypotension; Laparoscopic colorectal cancer resection

Core Tip: Alveolar recruitment maneuvers (ARMs) may lead to transient hypotension, but clinical characteristics of this hypotension are poorly understood. In the present study, we investigated characteristics of ARM-related hypotension in 140 patients undergoing laparoscopic colorectal cancer resection. The primary endpoint was an ARM-related hypotension. Risk factors for the hypotension were identified. When ARM was repeated intraoperatively, a quarter of subjects developed ARM-related hypotension, but only 3.61% of all the ARMs induced hypotension. ARM-related hypotension events most occurred at a hemodynamic instability or hypovolemic state, and in elderly subjects. Encouragingly, ARMs under pneumoperitoneum conditions had less impact on blood pressure.