الفهرس 
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Abstract
Laparoscopic surgery has become widely performed in pediatric age group due to its many advantages over open surgery. Lung collapse is a common complication of general anesthesia either with or without pneumoperitoneum and a major source of post-operative pulmonary complications. Lung recruitment maneuvers were typically used to reopen the collapsed lung. Despite being effective they weren’t devoid of complications. Lung ultrasound has recently become a cheap, effective, sensitive and radiation-free diagnostic tool for lung disorders and for performing lung recruitment under direct visualization for increased efficacy. The aim of the work was to compare the Safety and efficacy of ultrasound-guided lung recruitment maneuvers with conventional maneuvers performed without ultrasound guidance in preventing postoperative atelectasis after pediatric laparoscopic abdominal surgery. This study included ninety patients scheduled for laparoscopic abdominal surgery aged 1-6 years and ASA class I & II from both sexes, they were randomly allocated into two groups. group I (conventional group) received conventional lung recruitment without ultrasound guidance in the form of 5 cmH2O increments increase in PEEP on top of a steady airway pressure of 15 cmH2O until a peak pressure of 30 cmH2O is achieved. group II (ultrasound group) received Ultrasound-guided lung recruitment in the same manner, but the maximal pressure limit will be 40 cmH2O instead of 30 cmH2O. The recruitment maneuver was performed at 3 predefined time points: - 5 minutes after induction of GA (T2). - 5 minutes after insufflation of capnoperitoneum (T3). - After the end of surgery and before recovery from anesthesia (T4). The primary outcome was the incidence of atelectasis in post anesthesia care unit (PACU). The secondary outcomes were lung ultrasound (LUS) score at T1, T5 and T6, respiratory mechanics: peak airway pressure, PEEP, tidal volume and dynamic respiratory compliance, hemodynamic changes: MAP, HR, and peripheral oxygen saturation, the incidence of intraoperative and postoperative side effects. The two groups were comparable regarding demographic data, while LUS scores were significantly reduced after performing the recruitment maneuvers and lung compliance also increased in both groups after performing the recruitment maneuvers. Lung’s opening pressure in the ultrasound group ranged between 30-40 with median of 35 at all times of recruitment maneuvers suggesting the need of a peak pressure of more than 30 cmH2O for effective lung recruitment of children. Atelectasis was significantly reduced before PACU discharge in group II than in group I, also LUS scores were significantly reduced before PACU discharge in ultrasound group than in conventional group. The changes in hemodynamics and SpO2 weren’t clinically significantly different between the two groups, also there were no complications related to the procedure in any of the groups.