Correlation of Perioperative Atelectasis With Duration of Anesthesia, Pneumoperitoneum, and Length of Surgery in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Background During anesthesia, atelectasis is frequent, and it is also seen in critically ill individuals with a variety of underlying causes and pathologies. Objective The present study was conducted to assess whether there is a correlation between perioperative atelectasis and duration of anesthesia, pneumoperitoneum, and length of surgery in patients undergoing laparoscopic cholecystectomy. Material and methods Seventy-two American Society of Anesthesiologists (ASA) grade I-III patients of either gender undergoing elective laparoscopic cholecystectomy who met the inclusion criteria were enrolled in this observational study. The lung ultrasound (LUS) score was used to determine the amount of aeration loss. LUS scoring was performed at five predetermined time points: preoperative period (time point A), five minutes after induction (time point B), five minutes after pneumoperitoneum insufflation (time point C), end of surgery before extubation (time point D), and one hour after extubation in the postoperative room (time point E). Results At time points A, B, C, D, and E, vital parameters such as pulse rate, respiratory rate, oxygen saturation, and noninvasive blood pressure were continuously monitored and recorded. Hemodynamics remained stable, and no clinically significant changes in parameters were seen at any stage during the procedure. At each time point, the change in the LUS score was statistically significant (p-value = 0.01). Following the induction of general anesthesia, there was an increase in LUS scores, which increased further after the creation of pneumoperitoneum. Throughout the pneumoperitoneum and anesthetic periods in our investigation, the LUS score steadily climbed. Conclusion Even during short-term surgeries such as laparoscopic cholecystectomy, atelectasis can occur. The duration of pneumoperitoneum and ASA status can contribute to atelectasis.

Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver

“…General anesthesia can lead to the collapse of 10-15% of lung tissue [30]. The notable difference between this study and the one by Cinella et al [8] is the time point of the surgery where the RM was performed.…”

“…The PaO 2 /FiO 2 ratio demonstrated an increase of 63.8% before and after the RM. Patel et al [30] reported that even in short-term pneumoperitoneum (15-80 min), atelectases were found in the dependent part of the lung, as depicted on lung ultrasound intraoperatively. In a study by Monastesse et al [31], prolonged pneumoperitoneum was associated with an increased loss of aerated alveoli.…”

“…In a study by Monastesse et al [31], prolonged pneumoperitoneum was associated with an increased loss of aerated alveoli. In accordance with the literature [30,31], the RM was conducted post-desufflation to avoid the development of a new atelectasis in case it was performed at an earlier time point.…”

The role of ultrasound in predicting non-invasive ventilation outcomes: a systematic review

“…Several studies employ an ultrasonographic method of scoring lung pathology, namely the lung ultrasound score (LUS) (Table 1). A lung ultrasound score assessment is performed for multiple reasons, such as: perioperative oxygenation (31), predicting disease severity and mortality in ARDS (32), monitoring of lung aeration changes (after proning in ARDS, antimicrobial therapy in ventilator-associated pneumonia, selecting the ideal positive end-expiratory pressure, etc.) (33)(34)(35), weaning from mechanical ventilation (36), and as a prognosticator for respiratory failure (15, 18-20, 22, 28).…”

Comparison of Low-Pressure and Standard-Pressure Pneumoperitoneum Laparoscopic Cholecystectomy in Patients with Cardiopulmonary Comorbidities: A Double Blinded Randomized Clinical Trial

“…However, CO 2 in ation causes surgical stress, changes in blood circulation, and pulmonary compliance, and it may even increase intracranial pressures [2][3][4]. Approximately 21.5%, 21.2%, and 30.3% of patients may have decreased forced vital capacity (FVC), forced expiratory volume in one second, and forced expiratory ow at 25-75% of FVC, respectively [5][6][7].…”