Role of Lung Ultrasonography in Diagnosing Atelectasis in Robotic Pelvic Surgeries
Condition: Atelectasis
MeSH terms: Pulmonary Atelectasis
Study type: Observational

Summary: 
      General anaesthesia results in developement of atelectasis in dependent areas of the lungs
      exposing patients to an increased risk of hypoxaemia.During pelvic robotic surgeries
      pneumoperitoneum and steep trendelenburg position further increases atelectasis. Lung
      Ultrasound imaging is a promising , noninvasive , non-radiant, portable tool to study
      intraoperative lung atelectasis.
    

Detailed description: 
      Methodology -In the Operation Room 5 lead Electrocardiogram (ECG) , Pulse Oximetry (SPO2 ) ,
      Noninvasive blood pressure (NIBP), End tidal carbon di Oxide (ETCO2 )and core temperature
      will be monitored , intravenous assess will be established with large bore cannula ,under
      Local anesthesia Radial artery cannulation will be performed , standard general anesthesia
      with oral cuffed Endotracheal tube and Intermittent Positive Pressure Ventilation (IPPV )
      will be provided to all patients.Anaesthesia will be induced with Fentanyl 1-2 mcg/kg-1 ,
      Morphine 0.5mg/kg-1 ,Propofol sleeping dose , Atracurium 0.5mg/kg-1,and maintained with
      Air/O2 Sevoflurane , Propofol infusion @100- 150 mcg/kg-1 to maintain Bispectral Index (BIS)
      between 40 -60 and atracurium infusion to maintain Train -of - Four (TOF Ratio) < 0.5
      Baseline Lung Ultrasound Imaging will be performed to record 4 point Lung aeration score ( 0=
      Normal lung /No aeration loss , 1= mild aeration loss, 2=moderate aeration loss ,3=severe
      aeration loss ) at T1 - 5 minutes after induction of anaesthesia and before docking robotic
      instruments in 6 basal zones in both lungs ( 3 zones in each lung ) and labelled as Zone I
      (Right anterior basal ) Zone II ( Right lateral basal) and Zone III (Right posterior basal) .
      Zone IV ( Left anterior basal) , Zone V (Left lateral basal ) , Zone VI ( Left Posterior
      basal ).T2 - Lung Ultrasound Imaging will be performed to record aeration score after removal
      of robotic arms at the end of robotic surgery and before extubation in 6 basal zones in both
      lungs.Ti Arterial blood gas 5 minutes after induction of anesthesia and before docking
      robotic instruments.Tii -Arterial blood gas 5 minutes after the end of robotic surgery and de
      docking robotic instruments.All patients will receive Positive End Expiratory Pressure (PEEP)
      5 cms of water (H2O) intraoperatively . Intraabdominal Pressure will be maintained at 15 cms
      H2O. Any decrease in Oxygen saturation < 96 % and intervention required will be noted. At the
      end of surgery , neuromuscular blockade will be reversed , trachea extubated and patient
      shifted to Postanaesthesia Care Unit.
    

Intervention name(s): Lung Ultrasonography (Baseline); Lung Ultrasonography ( At the end of surgery)
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): Lung Ultrasonography will be performed prior to docking Robotic arms in basal three lung zones on both sides.; Lung Ultrasonography will be performed after removal of Robotic arms and before extubation in basal three lung zones on both sides to assess degree of atelectasis.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adult patients undergoing pelvic robotic surgery under general anaesthesia.
      
Keywords: Lung Ultrasonography; Step Trendelenburg position