Effects of recruitment maneuvre on atelectasis during prolonged paediatric microvascular anaesthesia: a computed Tomography study

Atelectasis is an unavoidable effect of general anaesthesia. The aim of this study was to identify lung atelectasis which could occur during general anaesthesia in children with healthy lungs during microscopic reconstruction of brachial plexus and to evaluate the efficacy of alveolar recruitment strategy [ARS] in treating such atelectasis guided by CTscanning, The study included 30 patients aged 4 months to 2 years, ASA I physical status. Three cases were excluded. 27 children were enrolled into two groups: control group [n=16] and Alveolar recruitment strategy [ARS] group [n=11]. After induction of anesthesia in the ARS group PEEP of 5 cm H[2]O was applied from the start of the operation and the recruitment manoeuvre was performed 1 hour after induction of anesthesia and repeated at the end of surgery and was performed for 10 breaths by increasing PEEP progressively to 10 cm H[2]O, and the tidal volume [TV] until 15 ml/kg or a peak inspiratory pressure [PIP] of 35 cm H[2]O. In the control group, arterial blood gas samples were withdrawn at the 1[st] hour, 4[th] hour and before extubation. In the ARS group, they were withdrawn at 1[st] hour [Control], after the 1[st] and the 2[nd] recruitment manoeuvres, and shunt fraction was mathematically calculated in both groups. Three computed tomography scans were performed in both groups; preoperatively, early and late postoperatively, and atelectatic area was identified and measured using the [Region-of-interest] program. The recruitment manoeuvre used in this study had succeeded to decrease the incidence of anesthesia induced atelectasis from 87.5% in the control group to 27.3% in the [ARS] group. Even in cases presented with atelectasis in the [ARS] group, the mean atelectatic area size was smaller, and its' resolution was earlier. In the control group, the mean atelectatic area size was 6.86 +/- 0.71 cm[2] in the early postoperative CT which further increased to 8.76 +/- 0.92 Cm[2] in the late postoperative CT, and 4 cases were complicated by pneumonia. In the [ARS] group, the mean area size was 3.82 +/- 1.55 cm[2] in the early postoperative CT, and reduced to 1.63 +/- 1.65 cm[2] in the late postoperative CT [3[rd] day], with no cases complicated by pneumonia. Furthermore, the degree of gas exchange impairment was improved in the [ARS] group versus the control group. The mean shunt fraction calculated from arterial blood gas in the control group was 14.76 +/- 1.63% versus 9.67 +/- 1.63% in the [ARS] group. The current study revealed a high incidence of anaesthesia-induced atelectasis in children with healthy lungs exposed to prolonged general anaesthesia for microscopic recostruction of brachial plexus birth injuries. The combined use of Alveolar recruitment manoeuvres and PEEP of 5 cm H[2]O before and afterwards is effective in reducing the incidence of anesthesia induced atelectasis with no reported complications

Role of CT in occult and submucosal laryngeal masses

CT was the prime radiologic examination for 20 patients [their ages ranged from 25-70 years] with submucosal laryngeal lesions. Hoarseness of voice was the main presenting symptom [14 patients], air way obstruction [3 patients], cervical adenopathy [2 patients], and one case with dysphagia. 16 of patients revealed positive endoscopic visibly focal bulge, and 4 other patients presenting with hoarseness and vocal cord paresis or paralysis had otherwise negative endoscopic findings. Biopsy proved squamous cell carcinoma in 12 which was the essential working diagnosis following CT in 10 patients. The 12 patients with squamous cell carcinoma underwent follow up endoscopic procedures. Other lesions included 3 cases laryngocele, 2 cases chondrosarcoma, and one case each fibrosarcoma, lymphoma, and tuberculous laryngitis