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Anaesthesia for laparoscopic surgery in paediatrics
S Baroncini1, A Gentili, A Pigna
1Department of Anesthesia, Resuscitation and Intensive and Analgesic Therapy, Anesthesia and Resuscitation Unit-Baroncini, S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.
Insights
Laparoscopic surgery in children offers reduced trauma and better cosmetic outcomes. This minimally invasive approach is safe and effective for pediatric patients, with physiological effects managed within normal ranges.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Anesthesiology
Background:
- Laparoscopic surgery is increasingly used for pediatric conditions.
- It offers benefits like reduced surgical trauma and improved cosmetic results.
- Physiological changes are linked to increased intra-abdominal pressure (IAP) from CO2 insufflation, patient positioning, and CO2 absorption.
Purpose of the Study:
- To evaluate the safety and clinical outcomes of laparoscopic surgery in pediatric patients.
- To assess the physiological effects of laparoscopic procedures in newborns, infants, and children.
Main Methods:
- Review of clinical experience with laparoscopic videosurgery in pediatric patients.
- Monitoring of respiratory, cardiocirculatory, and temperature parameters during procedures.
- Consideration of physiological impacts of increased IAP and patient positioning.
Main Results:
- Increased IAP significantly affects ventilation by reducing lung volumes and compliance.
- Pneumoperitoneum impacts cardiac function by altering ventricular preload and afterload.
- Controlled IAP (≤6 mmHg for neonates/infants, ≤12 mmHg for older children) is crucial.
- Observed respiratory, cardiocirculatory, and temperature changes were minimal and remained within normal limits.
Conclusions:
- Laparoscopic videosurgery is a safe and effective procedure for pediatric patients.
- Careful management of intra-abdominal pressure is essential for patient safety.
- Satisfactory clinical results can be achieved in newborns, infants, and children undergoing laparoscopy.
Abstract:
Laparoscopic surgery is an emerging procedure in the treatment of many surgical pathologies. Laparoscopy in the paediatric patient reduces surgical trauma and improves cosmetic RESULTS. Physiological changes during laparoscopic surgery are mainly related to the increased intra-abdominal pressure (IAP) associated with CO2 insufflation of the abdomen, the patient's postural modifications (head-up or head-down) and CO2 absorption and its general effects. Increases in IAP affect both ventilation and circulation. Increased IAP induces a mechanical compression of the diaphragm that reduces pulmonary compliance, vital capacity, functional residual capacity (FRC) and total lung volume. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The acute increase in IAP affects both preload and afterload, while the systolic cardiac performance remains unchanged. During anaesthesia for videolaparoscopy it is important not to exceed an intrabdominal pressure of 6 mmHg in newborns and infants and 12 mmHg in older children. In our clinical experience the respiratory, cardiocirculatory and temperature parameters have been slightly influenced during laparoscopy, but have always been maintained within the normal ranges. Laparoscopic videosurgery in newborns, infants and paediatric age group patients can be performed safely and with satisfactory clinical results.