Diaphragmatic Excursion Changes and Postoperative Oxygenation After Laparoscopic Cholecystectomy

N/ANot Yet RecruitingNCT07332728

Istinye University62 enrolled

Overview

Laparoscopic cholecystectomy and the associated pneumoperitoneum can impair diaphragmatic mechanics and reduce postoperative oxygenation. This prospective observational study aims to evaluate perioperative changes in diaphragmatic excursion measured by ultrasonography and to investigate their association with early postoperative oxygenation parameters and hypoxemia. By correlating diaphragmatic excursion changes with SpO₂/FiO₂ and the ROX index, the study seeks to clarify the physiological contribution of diaphragmatic dysfunction to postoperative hypoxemia in patients undergoing laparoscopic cholecystectomy.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Perioperative Diaphragmatic Excursion

Interventions

Standard perioperative care with observational diaphragm ultrasonographyOTHER

No therapeutic intervention is applied in this study. All patients receive standard perioperative anesthesia and surgical care according to institutional routine. Diaphragmatic excursion is assessed non-invasively using ultrasonography in the preoperative period and at 15 minutes postoperatively in the post-anesthesia care unit. Oxygenation parameters and respiratory variables are recorded for observational analysis only.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18-75 years * Scheduled for elective laparoscopic cholecystectomy under general anesthesia * Able to undergo diaphragm ultrasonography (no preoperative barrier to assessment) * Able to cooperate with preoperative and early postoperative diaphragm measurements * Postoperative oxygenation data available (SpO₂, FiO₂, and SpO₂/FiO₂ can be recorded) * Provided written informed consent Exclusion Criteria: * Morbid obesity (BMI ≥ 40 kg/m²) * Known diaphragmatic paralysis, phrenic nerve injury, or hemidiaphragm dysfunction * Severe COPD, restrictive lung disease, or advanced parenchymal lung disease * Preoperative home oxygen therapy or CPAP/BiPAP/home mechanical ventilation * Conversion to open surgery (laparoscopic → open) * Hemodynamic instability preoperatively or intraoperatively; emergency/complicated surgery * Factors preventing ultrasound assessment (e.g., marked upper abdominal gas, large scar/wound, severe subcutaneous edema) * Same-day discharge cases with \<24-hour observation * Inability to complete measurements (e.g., severe cognitive impairment, poor cooperation, severe pain preventing measurement) * Incomplete data not compatible with the protocol

Outcomes

Primary Outcomes

diaphragmatic excursion (ΔDE) and postoperative hypoxemia

Association between perioperative change in diaphragmatic excursion (ΔDE) and postoperative hypoxemia, defined as SpO₂ \< 92% and/or a clinically significant decrease in the SpO₂/FiO₂ ratio.

Time frame: Preoperative baseline and 15 minutes after admission to the post-anesthesia care unit (PACU).