Lung Recruitment in Laparoscpic Surgery

the effectiveness of different methods of lung recruitment maneuver on the incidence of atelectasis in adults undergoing laparoscopic cholecystectomy surgery using lung ultrasound Participants will be divided into three groups as: Control group, sustained inflation group (SI) and Stepwise POSITIVE pressure increasing group. Each contains 31 patients.

Control Group = Keep parameters all through the procedure without any changing GROUP(SI) = After abdominal deflation, The investigators will apply sustained inflation by adjusting Adjustible pressure valve 40 centimetres water spontaneous mode, holding the bag for 30 second.

Third group = After abdominal deflation, the investigators will apply stepwise POSITIVE pressure increasing by 2 centimeters water 5 breathing cycles till reaching 12 centimetres water and keeping it till extubation, with a maximum airway pressure not exceeding 40 centimetreswater.

During the entire procedure the transducer head will be placed over one point of the chest selected by the operator where the area of atelectasis was detected The probe will be placed in the atelectasis area.

Inclusion criteria

• Patients with healthy lungs

• Age between 18 and 65 years old
• Body mass index (BMI) <30 kg / m2
• Physical status I-II of the American Society of Anesthesiologists (ASA)
• Elective laparoscopic cholecystectomy.

Exclusion criteria

• Patient refusal
• Patients with preoperative ultrasound evidence of pulmonary atelectasis.
• Patients who will have conversion from laparoscopic to open surgery.
• Patients experiencing critical postoperative complications such as severe subcutaneous emphysema and pneumothorax.
• Patients with pulmonary, cardiac, and neuromuscular diseases and a corresponding surgical history and respiratory tract infections.