الفهرس 
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Abstract
Atelectasis is a side effect of general anesthesia which can be found in all types of interventions and in patients of all ages (Gunnarsson et al., 1991b). The reported incidence of anesthesia-induced atelectasis in children ranges from 12 to 42% in sedated and non-intubated patients (Lutterbey et al., 2007) and from 68 to 100% in children with general anesthesia with tracheal intubation or laryngeal mask (Tusman et al., 2003). Such lung collapse causes arterial blood oxygenation to decline during and after anesthesia (Kane et al., 2011) The dilemma of applying high or low perioperative FiO2 arises in the daily practice of pediatric anesthesia because children are at an increased risk of developing hypoxemia due to their physiological characteristics including smaller functional residual capacity and increased metabolic requirements compared with adults (Morrison 2000, Bouroche & Bourgain, 2015) Clinical studies showed a debate on the safety of the perioperative use of high versus low FiO2 and pediatric studies are lacking. Moreover, most of these studies investigated the effect of high FiO2 practice on the perioperative morbidity and mortality without sufficient focusing on atelectasis as an important adverse effect of this practice that can be a precursor for the PPCs afterwards (Lim et al., 2021, Høybye et al., 2022) lung ultrasound has shown reliable sensitivity and specificity for the diagnosis of anesthesia-induced atelectasis in children (Acosta et al., 2014) LUS can identify children needing a recruitment maneuver to re-expand their lungs and help optimize ventilator treatment during anesthesia (Acosta et al., 2017, Song et al., 2017, Tusman et al., 2017). The purpose of this study was to compare between two perioperative oxygenation strategies: the high versus low FiO2 strategy in pediatric patients undergoing lengthy microsurgery operations using the lung ultrasound as a bedside method for diagnosis and management of anesthesia-induced atelectasis. The primary outcome was the degree of anesthesia-induced atelectasis measured by the lung ultrasound score (LUS) performed in the intraoperative and early postoperative period. Patients In this prospective study the patients who underwent lengthy microsurgery operations according to the following inclusion criteria; Age: 2-12 years old, ASA physical status classification I-II and Undergoing lengthy microsurgery operations and requiring endotracheal intubation and mechanical ventilation for more than 4 hours. Excluded from the study patients with; ASA Physical status classification >II, Thoracic or abdominal surgery, Preexisting pulmonary, pleural and chest wall disease, pre-operative chest infection or abnormal chest US findings, Cardiac patients, Upper airways infections.