Atelectasis After Inhalation or Intravenous Induction in Pediatric Anesthesia

Study Overview
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Brief Summary
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Children have a highly compliant chest wall and atelectasis formation occurs often during pediatric anesthesia. Inhalation induction is commonly performed in pediatric anesthesia but it is still unclear if this can have an effect on the development of atelectasis. Aim of this study is to investigate the impact of inhalation versus intravenous induction on atelectasis formation during anesthesia induction in children. Atelectasis will be evaluated with lung ultrasound before induction and right after induction.

Detailed Description
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Respiratory complications, among which atelectasis, are a common cause of adverse events in pediatric anesthesia. Lung ultrasound (LUS) examination is a point of care, non-invasive, radiation-free tool with high sensitivity and specificity for the identification of anesthesia-induced atelectasis in children. Inhalation induction is commonly performed in pediatric anesthesia to avoid pain at venipuncture or to facilitate vein cannulation. This technique has been associated with a higher rate of respiratory adverse events but no study has investigated the role of inhalation or intravenous induction on lung atelectasis development in pediatric anesthesia. The investigators will perform this study aiming to describe the impact of inhalation versus intravenous induction technique on atelectasis formation during anesthesia induction in children of different ages.

Official Title
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Atelectasis Evaluated With Lung Ultrasound After Inhalation or Intravenous Induction in Pediatric Anesthesia: a Prospective, Observational, Propensity Scored Matched Study

Conditions
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Atelectasis, Pediatric Anesthesia

Intervention / Treatment
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* Other: Type of anesthesia induction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: scheduled for elective surgery under general anesthesia parental consent Exclusion Criteria: American Society of Anesthesiologists (ASA) physical status III-VI neuromuscular disease chronic lung disease cardiopathy thoracic cage malformations chronic home ventilation (either invasive or non-invasive) positive history of foreign body inhalation required immediate life-saving procedures lack of parental consent

Ages Eligible for Study
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Minimum Age: 0 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Inhalatory induction<br>Patients who will be induced via mask with inhalators anesthetic gases | Other: Type of anesthesia induction<br>* Patients will receive inhalatory or intravenous anesthesia at their choice; both groups will be evaluated with lung ultrasound after induction to detect ultrasonografic signs of atelectasis<br>|
| Intravenous induction<br>Patients who will be induced with intravenous anesthetics | Other: Type of anesthesia induction<br>* Patients will receive inhalatory or intravenous anesthesia at their choice; both groups will be evaluated with lung ultrasound after induction to detect ultrasonografic signs of atelectasis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global LUS score | Sum of the LUS scores given to all the lung areas. Score points vary from 0 to 4, where 0 means normality of the lung and 4 refers to serious compromise of normal ultrasound normality. | Upon completion of induction and subsequent controls at end of surgery and 1 postoperative day | 
| Signs of atelectasis | Number of lung areas presenting a sub pleural consolidation | Upon completion of induction and and subsequent controls at end of surgery and 1 postoperative day |