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Updated: Jun 17, 2026
Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
High-intensity transient signals during laparoscopic surgery in children
P Schramm1, K Engelhard, A Scherhag
1Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. schrammp@uni-mainz.de
Background:
Laparoscopic interventions in children gain increasing popularity. Pneumoperitoneum as applied during laparoscopic surgery can induce gas emboli formation, but it is unclear whether this is associated with cerebral embolic events. To investigate the hypothesis that pneumoperitoneum causes cerebral emboli in children, the number and intensity of high-intensity transient signals (HITS) detected using transcranial Doppler ultrasonography were assessed before and after induction of pneumoperitoneum.
Methods:
Twenty children were monitored during laparoscopic surgery. General anaesthesia was performed using sevoflurane and sufentanil or alfentanil. Pressure-controlled ventilation was adapted to maintain end-tidal Pco(2) (Pe'(co(2))) between 4.7 and 6.0 kPa. Baseline measurement of HITS rate, cerebral blood flow velocity, and mean arterial pressure (MAP) were recorded during steady-state anaesthesia before skin incision and during pneumoperitoneum with intra-abdominal pressure of 1.6-2.0 kPa applied using CO(2).
Results:
In 14 children (70%), HITS were detected during baseline and pneumoperitoneum. Three additional children (15%) developed HITS during pneumoperitoneum only and another three children (15%) presented no HITS during the investigation period. MAP and cerebral blood flow velocity increased with pneumoperitoneum.
Conclusions:
HITS are present in 70% of paediatric surgical patients under balanced anaesthesia before surgical interventions. Pneumoperitoneum further increased the occurrence of HITS.
