Atelectasis develops shortly after preoxygenation and induction of general anesthesia and impairs oxygenation by creating an intrapulmonary shunt. The pioneering use of computed tomography by Professor Göran Hedenstierna and collaborators in the 1980s opened the way to understanding the pathophysiology of perioperative atelectasis. Atelectasis occurs in most anesthetized patients, generally affecting a small portion of dependent lung regions, but is more conspicuous in certain conditions such as patients who are overweight, have abdominal distention, or are in the Trendelenburg position. Atelectasis may persist after surgery and may contribute to the development of postoperative pulmonary complications.

Atelectasis during general anesthesia may be prevented by limiting the fraction of inspired oxygen ([Fio2] “absorption atelectasis”) and by promoting alveolar recruitment with positive end-expiratory pressure (PEEP) and recruitment maneuvers. The effectiveness of these interventions has been thoroughly investigated during induction and maintenance of anesthesia. However, the...

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