Evaluation of the Effect of Lung Recruitment and Positive End- Expiratory Pressure (PEEP) on Anesthesia Induced Atelectasis Using Lung Ultrasound in Children Undergoing Major Abdominal Surgery.
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 40
- Locations
- 2
- Primary Endpoint
- The lung aeration score 5minutes following induction of general anesthesia
Study Overview
Brief Summary
Atelectasis is a side effect of general anesthesia which can be found in all types of interventions and patients of all ages.1-3 The reported incidence of anesthesia- induced atelectasis in children varies, ranging from 12 to 42% in sedated and nonintubated patients 5, 6 and from 68 to 100% in children with general anesthesia with tracheal intubation or laryngeal mask.
The aim of this work is to evaluate the effect of lung recruitment on anesthesia induced atelectasis using intraoperative lung ultrasound.
Objectives
- To determine the effect of recruitment on anesthesia induced atelectasis using lung ultrasound.
- To Estimate the change of Pao2 with anesthesia induced lung atelectasis.
- To Estimate the change of Pao2 with lung recruitment.
- To evaluate the feasibility of use of lung ultrasound as a tool to guide optimum lung recruitment.
Detailed Description
This a randomized control trial is designed to include 40 children aged from one to four years presented for major abdominal surgery.
Forty patients meeting the inclusion criteria will be randomly assigned into to two equal groups:
Group C (n= 20): Without recruitment maneuver (control group)
Group REC (n= 20): recruitment group
All children will be premedicated with oral midazolam 0.5mg/kg half hour before procedure and atropine at a dose of 0.01-0.02 mg/kg( IM). Continuous electrocardiogram (ECG) , pulse oximetry, non-invasive arterial blood pressure, and temperature monitoring will be applied and all patients will be induced with inhalational anesthetic using Sevoflurane+ oxygen(O2) with mac 2%. After deepening of the anesthesia, intravenous (I.V.) line will be inserted and fentanyl 2μg/kg, muscle relaxant will be given in the form of atracurium 0.5mg/kg and patients will be intubated by appropriate size of endotracheal tube.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description
Randomization will be done by computer generated numbers and concealed by serially numbered,opague and sealed envelopes. The details of the series will be unknown to the investigators and the group assignment will be kept in asset of sealed envelopes each bearing only the case number on the outside. Prior to surgery the appropriate numbered envelopes will be opened by the nurse, the card inside will determine the patient group
Eligibility Criteria
- Ages
- 1 Year to 4 Years (Child)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •ASA physical status I-II.
- •Age (1-4) years.
- •Patients undergoing major abdominal surgery in supine position (eg. Splenectomy, exploration, kasai etc.,).
Exclusion Criteria
- •Parents' refusal.
- •Patients with congenital heart disease.
- •Patients with chronic pulmonary disease ( asthma, bronchiectasis, emphysematous disease, etc.,)
- •Patients with respiratory tract infection.
- •Patients with chest wall deformities
Arms & Interventions
Without lung recruitment maneuver
patient ventilation will be maintained After induction of anesthesia all patients will be ventilated using pressure controlled mode targeting tidal volume 6-8 ml/kg with inspiratory to expiratory ( I: E) ratio 1:1.5 without recruitment but with PEEP 5cm H2O.
recruitment group
lung recruitment manoeuvre will be performed in patients using continuous positive airway pressure( CPAP) (30) cm H2O for (40) seconds after induction of anesthesia then patient will be converted to pressure controlled mode again with PEEP 5 cm H2O.
Intervention: lung recruitment maneuver (Procedure)
Outcomes
Primary Outcomes
The lung aeration score 5minutes following induction of general anesthesia
Time Frame: Lung ultrasound examinations will be performed 5minutes following induction of general anesthesia
Atelectasis will be assessed by ultrasound using lung aeration score applied for each region. Lung score is four points (0 = normal lung, 1 = moderate aeration loss, 2 = severe aeration loss, 3 = complete aeration loss and consolidation) so, applying score for 12 regions bilateral will result in maximum score 36 and lowest score 0
Secondary Outcomes
- •The sum of surface area of atelectatic regions(It will be measured at different time-points immediately before induction of anesthesia, 5, 15 minutes following induction of general anesthesia,5 min before extubation and 5 min after extubation at recovery room to detect and monitor atelectasis)
Investigators
Ahmed nabih youssef
Director, Anesthesia and surgical icu, Principal Investigator, Assistant lecturer
Kasr El Aini Hospital