TO DETECT EARLY ATELECTASIS IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY WITH LUNG ULTRASOUND IN PREOPERATIVE, INTRAOPERATIVE AND POST OPERATIVE PERIOD
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 1, Pages 1682-1692
AbstractBackground: Atelectasis is one of the frequently encountered postoperative pulmonary complication (PPC), with wide spectrum of causes related to perioperative events. The present study was conducted to detect early atelectasis in patients undergoing laparoscopic cholecystectomy with lung ultrasound in preoperative, intraoperative and post operative period.
Materials and Methods: In this observational study, seventy-two ASA grade I-III patients of either sex undergoing elective laparoscopic cholecystectomy who met the inclusion criteria were recruited. Mechanical ventilation was standardized. Images were obtained at five pre-defined time points and LUS scoring was done at these points. In pre-operative period(time point A), five minutes after induction(time point B), five minute after insufflation of pneumoperitoneum(time point C), at the end of surgery before extubation(time point D) and after 1 hour of post-extubation in postoperative room(time point E). Aeration loss was assessed by calculation of the LUS score. Each of the 12 lung quadrants were assigned a score of 0 to 3 according to a simple grading system. The LUS score (0–36) was calculated by adding up the 12 individual quadrant scores: with higher scores indicating more severe aeration loss. For Statistical analysis, difference between the proportions was tested by chi square test or Fisher ‟sex act test while difference between quantitative variable for more than group were tested by “ANNOVA” or Kruskal Wallis H test followed by post hoc test. Correlation between quantitative variables were seen by spearman correlation coefficient. P value lessthan 0.05 was considered statisticallysignificant.
Results: The vital parameters such as pulse rate, respiratory rate, oxygen saturation & non-invasive blood pressure were continuously monitored and recorded at time points A, B, C, D & E. Hemodynamics were stable and there was no clinically significant change in parameters at any point of time. Mean LUS score at time point A was 0.56±1.37, at time point B was 3.53±2.65, at time point C was 5.35±3.22, at time point D was 7.74±3.01 and at time point E was 2.97±1.98. Change in LUS score at each time point was statistically significant (p value <0.01). After induction of general anaesthesia, we observed an increased in LUS scores which further increased on production of pneumoperitoneum. In our study LUS score persistently increased throughout the period of pneumoperitoneum and anaesthesia. LUS score decreased one hour after extubation, however still did not reach preoperative score, hence some amount of aeration loss was there but it was clinically insignificant in our study.None of our patients had any episode of desaturation in postoperative period in recovery room. Although in our study has shorter duration of anaesthesia range (35 mins to 100 mins), we observed even in such short duration atelectasis occurred in dependent portion as noted by high LUS score. We observed a positive correlation between age of patient and change in LUS score in different time points. There was positive correlation between ASA status and loss of aeration(atelectasis).
Conclusion: In our study we observed that atelectasis does occur even during short duration of surgery like laparoscopic cholecystectomy. Bedside lung ultrasonography is feasible and useful point of care tool in detection of perioperative atelectasis.
- Article View: 34
- PDF Download: 28