Efficacy of a lung recruitment manoeuvre in children undergoing general anaesthesia with a supraglottic airway

Background Lung atelectasis is a well-recognised consequence of general anaesthesia in children and can cause poor oxygenation. Lung recruitment manoeuvre has been proposed as a strategy to counteract atelectasis. In this feasibility study, we evaluated whether a recruitment manoeuvre in children with a supraglottic airway restores end-expiratory lung volume (EELV) to baseline using electrical impedance tomography. Methods After ethics committee approval (BASEC 2022-01833), we included children (ASA physical status 1–2, 10–20 kg) scheduled for anaesthesia with a supraglottic airway. We performed a recruitment manoeuvre by setting an anaesthesia machine to spontaneous breathing with a 3 L min −1 fresh gas flow (fraction of inspired oxygen [Fio 2 ] 1.0) and the adjustable pressure-limiting (APL) valve set to 30 cmH 2 O, until a pressure plateau was reached or a leak occurred. Data were collected at three time points: after induction of anaesthesia (baseline), after placement of a supraglottic airway, and after recruitment manoeuvre. The primary endpoint was the normalised change in end-expiratory lung impedance after the recruitment manoeuvre. The global inhomogeneity index was a secondary outcome. Equivalence was assumed if the 95% confidence interval for estimated ΔEELV remained within ±35% (±2 ml kg −1 ). Results Of the 95 eligible children, we analysed 74 datasets. The median (95% confidence interval) estimated difference in EELV after recruitment manoeuvre vs baseline was −0.9 ml kg −1 (−1.6 to −0.1), within the equivalence margin. No significant changes in global inhomogeneity index (0.0 [0.03–0.04]) were observed. Conclusions In children undergoing general anaesthesia with the use of a supraglottic airway, a recruitment manoeuvre effectively restores EELV to baseline. Clinical trial registration NCT05672329