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Features of respiratory support during laparoscopic correction of inguinal hernias in children
Volodymyr Mishchuk1, Orest Lerchuk2, Andriy Dvorakevych3
1Department of Anestesiology and Intesive Care, Lviv Regional Children's Hospital "Ohmatdyt", Lviv, Ukraine.
Insights
Elevating intra-abdominal pressure during laparoscopic surgery in children negatively impacts respiratory mechanics. Maintaining pressure below 12 mm Hg is crucial for safe procedures and adequate gas exchange.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Surgical Innovation
Background:
- Laparoscopic surgery in children necessitates understanding respiratory mechanics under elevated intra-abdominal pressure (IAP).
- Carboxyperitoneum (CP) induces increased IAP, potentially altering respiratory function.
- Comparing pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) is essential.
Purpose of the Study:
- To investigate respiratory mechanics changes in children during laparoscopic surgery.
- To assess the impact of varying intra-abdominal pressure (IAP) levels on respiratory mechanics.
- To compare PCV and VCV ventilation effects under carboxyperitoneum conditions.
Main Methods:
- Fifty-two children (1-12 years) undergoing laparoscopic hernia repair were randomized to VCV or PCV.
- Respiratory mechanics were measured at baseline and with IAP from 6 to 14 mm Hg.
- Measurements included tidal volume, minute ventilation, lung compliance, and exhaled CO2.
Main Results:
- Increased IAP due to carboxyperitoneum worsened respiratory mechanics, causing restrictive changes in both VCV and PCV groups.
- PCV led to decreased tidal volume and lung compliance at IAP ≥ 12 mm Hg.
- VCV showed increased peak inspiratory and mean airway pressures, with reduced lung compliance.
- Elevated exhaled carbon dioxide (etCO2) was observed at IAP ≥ 12 mm Hg.
Conclusions:
- Carboxyperitoneum induces IAP elevation and restrictive respiratory disorders.
- Laparoscopic procedures in children over 1 year can be performed safely with IAP between 8-12 mm Hg.
- Careful monitoring of respiratory mechanics and IAP is vital during pediatric laparoscopic surgery.
Introduction:
The objectives were to study the changes in the mechanics of respiration in children undergoing surgery depending on the value of intra-abdominal pressure (IAP) during laparoscopic procedures, and to compare the effects of different mechanical ventilation modes - pressure controlled (PCV) and volume controlled (VCV) ventilation - on the mechanics of respiration considering carboxyperitoneum conditions (CP).
Aim:
To study the changes in the mechanics of respiration in operated children depending on the value of intra-abdominal pressure during laparoscopic procedures.
Material And Methods:
Fifty-two children aged 1-12 years undergoing laparoscopic surgery on inguinal hernias were randomly allocated to receive mechanical ventilation using either VCV (n = 24) or PCV (n = 28) mode. Respiratory mechanics were measured before application of carboxyperitoneum (initial data) and after the gas had been pumped into the abdominal cavity, at the following intra-abdominal pressure values: 6 mm Hg, 8 mm Hg, 10 mm Hg, 12 mm Hg, 14 mm Hg.
Results:
Elevation of intra-abdominal pressure due to carboxyperitoneum conditions had a negative effect on the mechanics of respiration. Changes in the respiratory mechanics were restrictive in nature in both groups. The patients who were receiving pressure controlled ventilation showed a decrease in tidal volume, exhaled minute volume, and dynamic lung compliance, which affected the gas exchange at intra-abdominal pressure values ≥ 12 mm Hg. Patients who were receiving volume controlled ventilation showed an increase in peak inspiratory pressure and mean airway pressure and a decrease in dynamic lung compliance in response to higher intra-abdominal pressure. A significant increase of concentration of exhaled carbon dioxide (etCO2) was registered at IAP ≥ 12 mm Hg.
Conclusions:
Application of carboxyperitoneum causes increased intra-abdominal pressure and restrictive disorders in respiratory mechanics. Intra-abdominal pressure readings within 8-12 mm Hg allow laparoscopic procedures to be performed without significant gas exchange disorders in children older than 1 year.
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