DOI: 10.36347/sjams.2019.v07i12.060

Pages: 4130-4136

Background and Aim: Atelectasis due to impaired respiratory mechanics and pulmonary gas exchange during general anaesthesia is compounded by alteration in chest wall mechanics due to compression resulting from pneumoperitoneum and position. PEEP has shown to counterbalance the diaphragm cranial shift increasing FRC and decreasing respiratory system elastance. This study aimed to determine the effect of PEEP on diaphragmatic functions in patients undergoing laparoscopic colorectal surgery using POCUS. Method: A prospective, randomized, comparative study was conducted between September 2018 and August 2019 after obtaining institutional ethical clearance. 90 patients fulfilling the inclusion criteria were allocated into three groups of 30 patients each. Standard anesthesia protocol was used for all three groups. Group I received mechanical ventilation without PEEP, group II received PEEP of 5 cm of H2O, and group III received PEEP of 10 cm of H2O. Excursion of diaphragm was measured using USG before induction of anesthesia, after pneumoperitoneum, after Trendelenburg position, every hour thereafter until completion of surgery, after recovery and 6 hour postoperatively. The vitals and lung function were recorded. Result: Amongst three group of patients with statistically similar age, sex, BMI and other confounding parameters, diaphragmatic excursion was lowest in Group I followed by Group II and maximum in Group III. The difference was statistically significant but at the cost of high mean PIP in Group III. Conclusion: In our study, PEEP of 5 cm of H2O was found effective in preserving diaphragmatic excursion and reducing compression atelectasis during laparoscopic colorectal surgeries.