Challenges in paediatric laparoscopic surgeries

Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular.The anaesthetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult. The pressure of pnemoperitoneum needs to be kept between 6-12cm H(2)O, flow of gas about 0.9l, ventilation to be controlled, temperature monitoring being essential, use of atropine as premedicant, intravenous fluid management to be meticulous, induction with sevoflurane preferred as children may not allow i.v.puncture, intraoperative surgical complications being more, one needs to be very vigilant to diagnose and treat it. Using periumbilical area in paediatric age group should be avoided because the umbilical vessels have not involuted and can get punctured.Thus careful management in paediatric laparoscopic surgery will assume an important place in paediatric surgery.