Abstracting and Indexing

• PubMed NLM
• Google Scholar
• Semantic Scholar
• Scilit
• CrossRef
• WorldCat
• ResearchGate
• Academic Keys
• DRJI
• Microsoft Academic
• Academia.edu
• OpenAIRE
• Scribd
• Baidu Scholar

Introduction: Postoperative hypoxemia is a common complication after general anesthesia, influenced by intraoperative ventilatory strategies. Optimal combinations of tidal volume and positive end-expiratory pressure (PEEP) remain uncertain. This study aimed to assess the impact of tidal volume and PEEP on postoperative oxygenation and clinical outcomes in patients undergoing general anesthesia for orthopedic surgery.

Methods: This single-center, two-by-two factorial crossover cluster trial included 80 patients undergoing elective orthopedic surgery. Participants were randomized into four ventilatory strategies, combining tidal volumes of 6 or 10 mL/kg predicted body weight with PEEP levels of 5 or 8 cm H2O. The primary outcome was the time-weighted average SpO₂/FiO₂ ratio during the first postoperative hour. Secondary outcomes included the incidence of hypoxemia, duration of oxygen supplementation, length of stay in the PACU, postoperative complications, and pain scores. Statistical analyses were conducted using two-way ANOVA and chi-square tests.

Results: Higher PEEP (8 cm H2O) significantly improved SpO₂/FiO₂ ratios (270 ± 20 vs. 240 ± 18, p = 0.003), reduced hypoxemia (15% vs. 30%, p = 0.02), and shortened PACU stays (40 ± 8 minutes vs. 50 ± 12 minutes, p = 0.01). Lower tidal volumes (6 mL/kg) were associated with fewer complications (5% vs. 20%, p = 0.02) and lower pain scores (4.5 ± 1.2 vs. 6 ± 1.8, p = 0.03). No significant interaction between tidal volume and PEEP was observed for the primary outcome.

Conclusion: Higher PEEP combined with lower tidal volumes improves postoperative oxygenation and reduces complications in patients undergoing orthopedic surgery. These findings support the use of lung-protective ventilation strategies during general anesthesia.