Intraoperative Valsalva maneuver: a narrative review

  • Chandra Mohan Kumar
  • André A. J. Van Zundert
Review Article/Brief Review


The Valsalva maneuver (VM) involves expiratory effort against a closed mouth and/or glottis in the sitting or supine position with the increased intraoral and intrathoracic pressure raised to 40 mmHg for 15-20 sec after which the pressure is suddenly released and the breathing restored to normal. Complex cardiovascular and other physiologic changes occur during the VM. The VM has been used for diagnostic and therapeutic reasons as well as intraoperatively during specific surgical procedures. Although the VM is usually safe, rare complications have been reported. This review examines the published literature surrounding the VM and explores the physiologic changes that occur during its performance. Attempts have been made to understand its intraoperative uses and complications and how these can be prevented.

Manœuvre de Valsalva peropératoire : une revue narrative


La manœuvre de Valsalva (MV) implique un effort expiratoire à bouche et/ou glotte fermées en position assise ou en décubitus, avec une pression intrabuccale et intrathoracique atteignant 40 mmHg pendant 15 à 20 secondes avant la levée soudaine du blocage et la reprise d’une respiration normale. Des modifications physiologiques et cardiovasculaires complexes surviennent durant la MV. La MV a été utilisée à des fins diagnostiques et thérapeutiques, et aussi en peropératoires au cours d’interventions chirurgicales spécifiques. Bien que la MV soit habituellement sans danger, de rares complications ont été décrites. Cette revue examine les publications entourant la MV et explore les changements physiologiques survenant au cours de sa réalisation. Des tentatives sont faites pour comprendre son utilisation et ses complications peropératoires et comment ces dernières peuvent être évitées.


Conflicts of interest

The authors declare no financial or any other conflict of interest.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author Contributions

Chandra Mohan Kumar and André A.J. Van Zundert contributed to the conception and design of the review, drafting the manuscript or revising it critically for important intellectual content, and final approval of the final manuscript.


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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Chandra Mohan Kumar
    • 1
    • 2
  • André A. J. Van Zundert
    • 3
    • 4
  1. 1.Newcastle UniversityEduCityMalaysia
  2. 2.Khoo Teck Puat HospitalYishunSingapore
  3. 3.Department of AnesthesiologyThe University of QueenslandBrisbaneAustralia
  4. 4.Department of Anesthesia & Perioperative Medicine, Royal Brisbane & Women’s Hospital – AnesthesiaThe University of QueenslandBrisbaneAustralia

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