The Role Intraoperative Salbutamol Inhaler in Preventing Atelectasis

Atelectases, Postoperative Pulmonary, Diabete Mellitus

atelectasis, salbutamol, pulmonary, bronchodilator

Atelectasis is considered a common complication in the perioperative period, especially following surgeries under general anesthesia. Postoperative atelectasis could occur anytime during the perioperative period from intraoperative period to 24 hours postoperative and contribute to a variety of other complications, including hypoxemia and pneumonia. In the literature, several methods were utilized to combat this phenomenon, therefore, we investigate the role of intraoperative salbutamol in reducing the incidence of atelectasis. It is well known that salbutamol could be an adjunctive bronchodilator medication used in the intraoperative anesthetic regimens.

Atelectasis is the collapse or incomplete expansion of the lung or a part of it, resulting in impaired gas exchange and potential hypoxemia. It is a common complication in various clinical settings, particularly after surgery, and can contribute to increased morbidity and prolonged hospital stay. The incidence of atelectasis varies widely depending on the patient population and type of surgical procedure. Postoperative atelectasis is reported in up to 90% of patients undergoing general anesthesia, with higher rates observed in thoracic and upper abdominal surgeries. In pediatric populations, the incidence may range from 10-25%, especially following gastrointestinal or thoracic procedures. Key risk factors include general anesthesia, postoperative pain, obesity, advanced age, smoking, prolonged immobility, neuromuscular disorders, and mechanical ventilation. These factors contribute to reduced diaphragmatic motion, impaired mucociliary clearance, and decreased alveolar ventilation. There are several causes of atelectasis in the postoperative period which results from a combination of factors that impair normal lung expansion and ventilation as reduced functional residual capacity as general anesthesia decreases FRC below closing volume, especially in dependent lung areas, promoting alveolar collapse. Impaired diaphragmatic function as pain and muscle relaxation reduce diaphragmatic motion, limiting lung inflation post-surgery. In addition, mucus retention due to suppressed cough reflex and ciliary function leads to resorptive (obstructive) atelectasis. Another important mechanism for atelectasis is airway obstruction and reflex bronchospasm. Management of atelectasis depends mainly on prevention and lung re-expansion strategies and it is divided according to period. In the preoperative period, smoking cessation at least 4-8 weeks before surgery reduces risk and patient education on deep breathing and coughing exercises. In the intraoperative period, the use of lung-protective ventilation as low tidal volumes with adequate PEEP (positive end-expiratory pressure) to prevent alveolar collapse \[5\]. Recruitment maneuvers during surgery to reopen collapsed alveoli. Furthermore, the use of postoperative nebulizers such as bronchodilator (salbutamol) and steroids has been shown to benefit those patients. Our hypothesis is that intraoperative salbutamol inhaler will lead to a reduction in the incidence and severity of atelectasis especially in diabetic patients. Therefore our primary aim of the study is to examine the incidence of atelectasis in diabetic patients compared to standard anesthesia and surgery techniques in our institution.in addition, outcomes such as severity of the atelectasis, overall hospital stay, side effects of salbutamol, hypoxia and pneumonia.

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