Role of lung ultrasonography for diagnosing atelectasis in robotic pelvic surgeries

Abstract

Patients undergoing robotic pelvic surgery were included in prospective observational study, they are at increased risk of atelectasis and postoperative pulmonary complications.Lung ultrasonography in basal six zones and arterial gas analysis was performed as baseline after induction of GA and on de-docking robotic arms to detect incidence and severity of atelectasis and its effect on arterial oxygenation.Total fifty patients were recruited in the study with age 61.88 ± 8.49 years, BMI 25.97±4.03, intraoperative with steep trendelenburg position, average duration of docking was 155.32 ± 47.44 minutes, VCV provided to 29 and PCV to 21 patients. [Lung aeration score 0] was noted for all patients in Right anterior basal –Zone I, 50-60% of patients developed mild atelectasis [Lung Aeration score1] in Posterior basal zones III and VI. Total 10% patients developed moderate atelectasis [Lung Aeration score 2] and 4% developed severe atelectasis [Lung Aeration score 3] in zones III and VI. The incidence and severity of atelectasis was not affected by duration of robotic arms docking and mode of ventilation. For both VCV and PCV group statistically significant (p>0.05) decrease in Arterial Oxygen Pressure (Pao2) and Alveolar-arterial (A-a)o gradient difference was detected after completion of robotic surgery compared to baselines values. Atelectasis was detected in 60% patients in bilateral basal posterior zones in patients undergoing robotic pelvic surgeries causing statistically significant decrease in PaO2 compared to baseline values. Early detection of atelectasis by Lung Ultrasonography in the OR and applying optimal PEEP is recommended.