Lung recruitment maneuvers: Opening the door to a hidden enemy

Abstract Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoingsurgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electricalactivity immediately after RMs. A transoesophageal echocardiogram performed after return ofspontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunctionwith segmental changes, and air in the left ventricle, leading to suspicion of paradoxical airembolism. The contractility changes normalised spontaneously, and postoperative evolutionwas uneventful. RMs cause changes in intracavitary pressures that can lead to opening of a PFO (present in up to 30 % of the population) and reversal of the physiological left-right shunt. Transoesophageal echocardiography facilitated immediate diagnosis and follow-up.