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Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair
Gloria Pelizzo1, Luciano Bernardi2, Veronica Carlini1
1Department of Maternal and Child Health, Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Insights
Intra-abdominal pressure increases during pediatric laparoscopy significantly decrease brain oxygenation. Monitoring cerebral oxygen saturation is crucial for patient safety in these procedures.
Area of Science:
- Pediatric Anesthesiology
- Minimally Invasive Surgery
- Cerebral Hemodynamics
Background:
- Systemic effects of intra-abdominal pressure (IAP) and carbon dioxide (CO2) during laparoscopy are not well-defined in children.
- Previous studies suggest potential cerebral hypotension and perfusion changes.
- No data exists on pediatric brain oxygenation during routine laparoscopy.
Purpose of the Study:
- To investigate brain and peripheral oxygenation during laparoscopic surgery in children.
- To assess the impact of IAP and CO2 insufflation on cerebral oxygen saturation (rScO2).
Main Methods:
- 10 children undergoing elective inguinal hernia repair were monitored.
- Regional cerebral oxygen saturation (rScO2) via NIRS, peripheral oxygen saturation, and heart rate (HR) were recorded.
- Measurements were taken at five intervals: pre-insufflation, during CO2 insufflation, and post-insufflation.
Main Results:
- Significant decreases in rScO2 were observed immediately after anesthesia induction and became significant after CO2 insufflation (3.6 ± 0.38%).
- rScO2 levels were restored after pneumoperitoneum cessation.
- Increased IAP was the primary driver of rScO2 changes, while HR changes correlated with pneumoperitoneum pressure and CO2 flow rate.
Conclusions:
- Increased IAP is a critical factor affecting cerebral oxygenation stability during pediatric laparoscopy.
- Anesthesia's impact on adaptive changes requires careful consideration.
- Close multidisciplinary team monitoring is essential for patient safety.
Background:
The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients.
Patients And Methods:
Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2insufflation induced pneumoperitoneum (PP) (T2); CO2PP insufflation (T3); cessation of CO2PP (T4); before extubation (T5).
Results:
rScO2decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2decreased 3.6 ± 0.38%); restoration of rScO2was achieved after PP cessation (P = 0.007). The changes in rScO2were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2flow rate (P = 0.001). No significant peripheral effects were noted.
Conclusions:
The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.
