Luciano Frassanito1, Chiara Sonnino2, Sara Pitoni3, Bruno A Zanfini2, Stefano Catarci2, Gian L Gonnella2, Paolo Germini2, Giuseppe Vizzielli4, Giovanni Scambia4, Gaetano Draisci2. 1. Unit of Anesthesia in Obstetrics, Gynecology and Pain Therapy II, Department of Emergency, Anesthesiology and Intensive Care Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - lucfras75@hotmail.com. 2. Unit of Anesthesia in Obstetrics, Gynecology and Pain Therapy II, Department of Emergency, Anesthesiology and Intensive Care Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. 3. Department of Emergency, Anesthesiology and Intensive Care Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. 4. Unit of Gynecologic Oncology, Department of Women's, Children's and Public Health Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.
Abstract
BACKGROUND: Atelectasis formation is considered the major cause of hypoxemia during general anesthesia (GA). Gynecologic oncologic surgery (GOS) often requires pneumoperitoneum and steep bed angulation that further reduce lung compliance by shifting bowels and diaphragm. The aim of our study was to assess the impact of intraoperative variables on lung aeration using lung ultrasound (LUS) score and their correlation with postoperative oxygenation in women undergoing GOS. METHODS: In this prospective observational study 80 patients scheduled for GOS were enrolled. After three minutes pre-oxygenation, propofol-sufentanil-sevoflurane GA and standard mechanical ventilation (MV) were administered (tidal volume of 8 mL/kg of predicted body weight, FiO<inf>2</inf> 40%, I:E ratio of 1:2 and PEEP 5 cm H<inf>2</inf>O). A 0-36 LUS score was calculated considering 12 pulmonary areas, and arterial blood gas analysis were performed before GA (T1) and in recovery room (T2). RESULTS: LUS score increased significantly between T1 (1.79±2.39) and T2 (11.08±4.40, ΔLUS=9.29±4.10, P<0.05), mostly in basal and posterior areas. Changes in LUS score correlated significantly with time of MV (r=0.246, P<0.05), cumulative time in TR position (r=0.321, P<0.05) and worsening in oxygenation (ΔPaO<inf>2</inf>/FiO<inf>2</inf>, r=-0.260, P<0.05). ΔLUS score significantly correlated with colloid infusion. The linear regression analysis showed that TR time can predict ΔLUS score (F<inf>1,78</inf>=8.97, P=0.004). No correlation was found with pneumoperitoneum, apnea time at induction and TR angle. CONCLUSIONS: Aeration loss after GOS detected using LUS correlates with TR time, MV time, colloid infusion and worsening in oxygenation.
BACKGROUND: Atelectasis formation is considered the major cause of hypoxemia during general anesthesia (GA). Gynecologic oncologic surgery (GOS) often requires pneumoperitoneum and steep bed angulation that further reduce lung compliance by shifting bowels and diaphragm. The aim of our study was to assess the impact of intraoperative variables on lung aeration using lung ultrasound (LUS) score and their correlation with postoperative oxygenation in women undergoing GOS. METHODS: In this prospective observational study 80 patients scheduled for GOS were enrolled. After three minutes pre-oxygenation, propofol-sufentanil-sevoflurane GA and standard mechanical ventilation (MV) were administered (tidal volume of 8 mL/kg of predicted body weight, FiO<inf>2</inf> 40%, I:E ratio of 1:2 and PEEP 5 cm H<inf>2</inf>O). A 0-36 LUS score was calculated considering 12 pulmonary areas, and arterial blood gas analysis were performed before GA (T1) and in recovery room (T2). RESULTS: LUS score increased significantly between T1 (1.79±2.39) and T2 (11.08±4.40, ΔLUS=9.29±4.10, P<0.05), mostly in basal and posterior areas. Changes in LUS score correlated significantly with time of MV (r=0.246, P<0.05), cumulative time in TR position (r=0.321, P<0.05) and worsening in oxygenation (ΔPaO<inf>2</inf>/FiO<inf>2</inf>, r=-0.260, P<0.05). ΔLUS score significantly correlated with colloid infusion. The linear regression analysis showed that TR time can predict ΔLUS score (F<inf>1,78</inf>=8.97, P=0.004). No correlation was found with pneumoperitoneum, apnea time at induction and TR angle. CONCLUSIONS: Aeration loss after GOS detected using LUS correlates with TR time, MV time, colloid infusion and worsening in oxygenation.