Anesthesia & Analgesia: September 23, 2016
AUTHORS: Monastesse, Audrey MD et al
BACKGROUND: Few diagnostic tools are available to anesthesiologists when confronted with intraoperative hypoxemia. Lung ultrasonography is a safe and accurate bedside imaging modality. The aim of this study was to evaluate the feasibility of lung ultrasonography during the perioperative period and assess its ability to detect intraoperative respiratory complications and oxygenation changes resulting from perioperative atelectasis.
METHODS: In this prospective observational pilot study, 30 consecutive patients scheduled for laparoscopic surgery were recruited. Mechanical ventilation was standardized. Lung ultrasonography was performed at 5 predefined time points: before induction of general anesthesia (GA), after induction of GA, after pneumoperitoneum insufflation, on arrival in the recovery room, and before recovery room discharge. For each echographic examination, 12 pulmonary quadrants were imaged. From these, a semiquantitative score, the lung ultrasound (LUS) score, was calculated to assess lung aeration at each time point.
RESULTS: Lung ultrasonography was possible in all patients. Changes in the LUS score between the postinduction period and arrival in the recovery room were correlated with changes in oxygenation (Spearman r = -0.43, P = .018). Induction of GA was associated with an increase in the LUS score, which gradually worsened at all time points until recovery room discharge. This increase was significantly worse in the basal and dependent lung zones. Lung ultrasonography helped in the detection of 2 capnothoraces, 1 endobronchial intubation, and 1 episode of subclinical pulmonary edema.
CONCLUSIONS: Lung ultrasonography in the perioperative period is feasible, allows tracking of perioperative atelectasis, and facilitates the diagnosis of respiratory complications. The evolution of aeration loss correlates moderately with changes in oxygenation.