• Luciano Frassanito, Chiara Sonnino, Sara Pitoni, Bruno A Zanfini, Stefano Catarci, Gian L Gonnella, Paolo Germini, Giuseppe Vizzielli, Giovanni Scambia, and Gaetano Draisci.
• 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.
• Minerva Anestesiol. 2020 Dec 1; 86 (12): 1287-1295.

BackgroundAtelectasis 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.MethodsIn 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, FiO2 40%, I:E ratio of 1:2 and PEEP 5 cm H2O). 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).ResultsLUS 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 (ΔPaO2/FiO2, 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 (F1,78=8.97, P=0.004). No correlation was found with pneumoperitoneum, apnea time at induction and TR angle.ConclusionsAeration loss after GOS detected using LUS correlates with TR time, MV time, colloid infusion and worsening in oxygenation.

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