Comparison of the Effect of Different Positive End-Expiratory Pressures on Intraoperative Lung Dynamics and Hemodynamics Using Laryngeal Mask Airway for Hemorrhoidectomy in Adult Patients under General Anesthesia

Ayesha Rasool; Fariha Aslam; Shumaila Ali Rai; Muhammad Aatir Fayyaz; Nadeem Ahmad Khan

doi:10.54112/bcsrj.v6i7.2382

Authors

Ayesha Rasool Department of Anaesthesia & ICU, Nishtar Medical University and Hospital Multan, Pakistan
Fariha Aslam Department of Anaesthesia & ICU, Nishtar Medical University and Hospital Multan, Pakistan
Shumaila Ali Rai Department of Anaesthesia & ICU, Nishtar Medical University and Hospital Multan, Pakistan
Muhammad Aatir Fayyaz Department of Anaesthesia & ICU, Nishtar Medical University and Hospital Multan, Pakistan
Nadeem Ahmad Khan Department of Anaesthesia & ICU, Nishtar Medical University and Hospital Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i7.2382

Keywords:

Anesthesia, General; Hemodynamics; Laryngeal Masks; Positive-Pressure Respiration

Abstract

General anaesthesia can impair pulmonary mechanics and reduce lung compliance, particularly during controlled ventilation. Appropriate positive end-expiratory pressure may improve intraoperative lung dynamics while maintaining cardiovascular stability. Objective: To compare the effects of zero end-expiratory pressure (ZEEP) and positive end-expiratory pressure (PEEP) of 5 mbar on intraoperative lung dynamics and hemodynamic parameters in adult patients undergoing hemorrhoidectomy under general anaesthesia using a laryngeal mask airway. Methods: This randomized controlled trial was conducted in the Department of Anaesthesiology, Nishtar Hospital, Multan, from 7 November 2024 to 7 May 2025. A total of 86 patients aged 20–50 years, with American Society of Anesthesiologists physical status I or II, undergoing surgery for grade III or IV hemorrhoids were randomly allocated to either the ZEEP group (n=43) or the PEEP 5 mbar group (n=43). Dynamic lung compliance, tidal volume, peak inspiratory pressure, heart rate, and mean arterial pressure were assessed at 10, 20, and 30 minutes after induction of general anaesthesia. Data were analyzed using IBM SPSS Statistics version 26. Continuous variables were summarized as mean ± standard deviation, between-group comparisons were performed at predefined time points, and p<0.05 was considered statistically significant. Results: The mean age of the participants was 38.4 ± 7.2 years; 54 (62.8%) were male, and the mean body mass index was 24.7 ± 2.4 kg/m². Dynamic lung compliance was significantly higher in the PEEP group than in the ZEEP group at 10 minutes (48.6 ± 7.0 vs 42.7 ± 6.4 mL/cmH₂O), 20 minutes (51.0 ± 7.1 vs 43.3 ± 6.5 mL/cmH₂O), and 30 minutes (51.7 ± 7.2 vs 42.8 ± 6.6 mL/cmH₂O; all p<0.001). Tidal volume was significantly higher with PEEP at 20 minutes (478 ± 49 vs 455 ± 46 mL; p=0.027) and 30 minutes (482 ± 50 vs 453 ± 48 mL; p=0.007). Peak inspiratory pressure was higher in the PEEP group at all measurement points (all p<0.001). Heart rate and mean arterial pressure did not differ significantly between the groups at any assessment point (all p>0.05). Conclusion: PEEP of 5 mbar during LMA-based general anaesthesia improved dynamic lung compliance and maintained higher tidal volumes without significant hemodynamic instability. These findings support modest PEEP as an effective ventilation strategy for appropriately selected adults undergoing short elective procedures.

Downloads

Download data is not yet available.

0

References

1. O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ. 2018;362.

2. Pereira SM, Tucci MR, Morais CCA, Simões CM, Tonelotto BFF, Pompeo MS, et al. Individual positive end-expiratory pressure settings optimize intraoperative mechanical ventilation and reduce postoperative atelectasis. Anesthesiology. 2018;129(6):1070-1081.

3. 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. 2019;321(23):2292-2305.

4. Östberg E, Thorisson A, Enlund M, Zetterström H, Hedenstierna G, Edmark L. Positive end-expiratory pressure and postoperative atelectasis: a randomized controlled trial. Anesthesiology. 2019;131(4):809-817.

5. Deng QW, Tan WC, Zhao BC, Wen SH, Shen JT, Xu M. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials. Br J Anaesth. 2020;124(3):324-335.

6. Hol L, Nijbroek SGLH, Schultz MJ. Perioperative lung protection: clinical implications. Anesth Analg. 2020;131(6):1721-1729.

7. Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ. 2020;368.

8. Gao X, Liu JH, Chen CM, Wang Y, Wang ZY, Yan CL, et al. Comparison of the supraglottic airway device BlockBuster and laryngeal mask airway Supreme in anaesthetised, paralyzed adult patients: a multicenter randomized controlled trial. Expert Rev Med Devices. 2022;19(8):649-656.

9. Hung KC, Wu SC, Hsu CW, Ko CC, Chen JY, Huang PW, et al. Efficacy of laryngeal mask airway against postoperative pharyngolaryngeal complications following thyroid surgery: a systematic review and meta-analysis of randomized controlled studies. Sci Rep. 2022;12(1):18210.

10. Yessenbayeva GA, Yukhnevich YA, Khamitova ZK, Kim SI, Zhumabayev MB, Berdiyarova GS, et al. Impact of a positive end-expiratory pressure strategy on oxygenation, respiratory compliance, and hemodynamics during laparoscopic surgery in non-obese patients: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2023;23(1):371.

11. Ullmann H, Renziehausen L, Geil D, Sponholz C, Thomas-Rüddel D, Völker MT, et al. The influence of positive end-expiratory pressure on leakage and oxygenation using a laryngeal mask airway: a randomized trial. Anesth Analg. 2022;135(4):769-776.

12. Zhang C, Xu F, Li W, Tong X, Xia R, Wang W, et al. Driving pressure-guided individualized positive end-expiratory pressure in abdominal surgery: a randomized controlled trial. Anesth Analg. 2021;133(5):1197-1205.

13. Kim YJ, Kim BR, Kim HW, Jung JY, Cho HY, Seo JH, et al. Effect of driving pressure-guided positive end-expiratory pressure on postoperative pulmonary complications in patients undergoing laparoscopic or robotic surgery: a randomised controlled trial. Br J Anaesth. 2023;131(5):955-965.

14. Scharffenberg M, Mandelli M, Bluth T, Simonassi F, Wittenstein J, Teichmann R, et al. Respiratory mechanics and mechanical power during low vs high positive end-expiratory pressure in obese surgical patients: a sub-study of the PROBESE randomized controlled trial. J Clin Anesth. 2024;92:111242.

15. Liu B, Wang Y, Li L, Xiong W, Feng Y, Liu Y, et al. The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: a randomized controlled trial. J Clin Anesth. 2024;98:111564.

16. Yu J, Wu Z, An R, Li H, Zhang T, Lin W, et al. Association between driving pressure and postoperative pulmonary complications in patients undergoing lung resection surgery: a randomised clinical trial. Anaesth Crit Care Pain Med. 2023;42(1):101160.

17. Piccioni F, Langiano N, Bignami E, Guarnieri M, Proto P, D'Andrea R, et al. One-lung ventilation and postoperative pulmonary complications after major lung resection surgery: a multicenter randomized controlled trial. J CardiothoracVasc Anesth. 2023;37(12):2561-2571.

18. Luo Y, Qin S, Liu M, Shen Q, An R, Jiang Y. Individualized positive end-expiratory pressure guided by driving pressure in robot-assisted laparoscopic radical prostatectomy: a prospective, randomized controlled clinical trial. Front Med (Lausanne). 2025;12:1573150.

19. Yang L, Wu L, Ye J, Zhao Z, Zhang J. Applying positive end-expiratory pressure to facemask ventilation improves post-induction lung atelectasis: a three-arm randomized controlled trial. BMC Anesthesiol. 2025;25(1):509.

20. Writing Committee; Steering Committee; PROTHOR Collaborative Group; PROtectiveVEntilation Network (PROVE Network) for the Clinical Trial Network of the European Society of Anaesthesiology and Intensive Care. Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial. Lancet Respir Med. 2026;14(1):17-28.

21. Kim YJ, Lee H, Yoon HK, Kim HS. Effect of individualized positive end-expiratory pressure titration guided by electrical impedance tomography on oxygenation in patients undergoing laparoscopic surgery in the lateral decubitus position: a randomized controlled study. Korean J Anesthesiol. 2026;79(2):201-212.

22. Vijayakumar L, Thirunavukkarasu PL, Barathi A. Effect of intraoperative positive end-expiratory pressure on post-operative pulmonary complications in overweight patients undergoing elective laparoscopic hernia surgery: a prospective randomised controlled trial. J Minim Access Surg. 2026;22(2):149-155.