Abstract No.: ABS1045: Ultrasonographic evaluation of the effect of positive end expiratory pressure andpulmonary recruitment maneuver on diaphragmatic functions in patients undergoing laparoscopic abdominal surgery

Abstract

Background & Aims:Reports suggest diaphragmatic impairment after laparoscopic abdominal surgery by gas insufflation causes postoperativepulmonary dysfunction. Intraoperative PEEP, recruitment maneuver prevents lung atelectasis mitigating complications.The aim was to evaluate effects of PEEP,pulmonary recruitment maneuver on diaphragmatic functions during pneumoperitoneum in patients undergoing laparoscopic surgeriesMethods:After ethical committee clearance and patient consent, a randomised control trial conducted among 63 patients undergoing laparoscopic abdominal surgeries under GA. Patient belonging to ASA 1,2 and giving informed written consent were includedthose having severe systemic illness, BMI>30 were excluded. Patients undergoing laparoscopic abdominal surgery under GAwere randomized using computer generated numbers into three equal groups, A with zero PEEP, B with 5 PEEP, C withpulmonary recruitment maneuver. Perioperatively diaphragmatic excursion, intraoperatively peak inspiratory pressure, hemodynamic parameters (MAP, HR) and dynamic compliance of the lungs were measured. Mann Whitney U test were applied.Results:Mean diaphragmatic excursion in cm at baseline, after pneumoperitoneum, reverse Trendelenburg position, extubation, 6 h postoperatively in Group A (3.63+0.28,.040+18,3.08+0.008,2.88+0.34,3.56+0.33,) Group B (3.65+0.27,3.29+0.30,3.13+0.29,3.40+0.37,3.65+0.29), Group C (3.75+0.31,3.41+0.28,3.20+0.30,3.40+0.34,3.74+0.31), p value (0.743,0.742,0.000,0.000.0.000), Mean Peak inspiratory pressure in mmhg before and after applying PEEP, after pneumoperitoneum and reverse Trendelenburg in Group A (16.11+0.90,16.04+0.89,22.01+1.20,22.06+1.27) Group B (16.19+1.03,16.73+2.74,22.44+1.39,23.98+2.28), Group C (16.21+1.05,16.73+2.72,22.44+1.33,25.96+2.28), p value (0.236,<0.001,<0.001,0.001), Dynamic compliance was statistically significantly lower in Group A compared to Group B and Group C at all time points, although there is no statistical difference between B,C groups, values were higher in Group C throughout. Conclusion:Application of PEEP is helpful for preserving diaphragmatic excursion during laparoscopic abdominal surgeries. In thepresent study pulmonary recruitment maneuver improved diaphragmatic excursion and dynamic compliance, although there was significant increase in peak inspiratory pressure compared to other groups.