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Cardiorespiratory changes during laparoscopic fundoplication in children
M Sfez1, A Guérard, P Desruelle
1Clinique Chirurgicale de Boulogne-Billancourt, France.
Insights
Laparoscopic Nissen fundoplication in children is safe, with careful management of anesthesia and potential complications like hypoxia. This study assessed cardiorespiratory changes in 25 pediatric patients undergoing the procedure.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Cardiorespiratory Physiology
Background:
- Laparoscopic Nissen fundoplication is a common procedure for gastroesophageal reflux disease in children.
- Assessing cardiorespiratory changes during this surgery is crucial for patient safety.
Purpose of the Study:
- To prospectively evaluate cardiorespiratory changes during laparoscopic Nissen fundoplication in pediatric patients.
- To identify potential anesthetic and surgical risks and complications.
Main Methods:
- Prospective assessment of 25 children (1.2–14.3 years) undergoing laparoscopic Nissen fundoplication.
- Monitoring cardiorespiratory parameters, intra-abdominal pressure, and anesthetic effects.
- Evaluation of postoperative outcomes including hypoxia and analgesia.
Main Results:
- 68% of patients had pre-existing respiratory disease or esophagitis.
- Transient hypotension or bradycardia occurred in 3 cases pre-insufflation.
- Postoperatively, 25% experienced transient hypoxia; analgesia duration varied widely.
- Hospital stay averaged 5.6 days.
Conclusions:
- Laparoscopic pediatric fundoplication is safe when hypovolemia and postoperative hypoxia are proactively managed.
- Balanced inhalational anesthesia requires careful monitoring for hemodynamic and respiratory events.
- The procedure can be performed safely with appropriate perioperative care.
Abstract:
The results of a prospective assessment of cardiorespiratory changes related to anaesthesia and laparoscopic Nissen fundoplication are described in 25 children aged 1.2 to 14.3 years, weighing 9.0 to 64.0 kg. Respiratory disease or oesophagitis were present in 68% cases. During balanced inhalational anaesthesia, hypotension or bradycardia occurred prior to peritoneal insufflation in three cases of reverse Trendelenburg position. During surgery, intra-abdominal pressure was in the 6-10 mmHg range. Transiently, two patients were hypotensive while ten were hypertensive. PETCO2 gradually increased but only two patients required increased minute ventilation. One bronchial intubation episode developed. Airway complications were related to isoflurane administration. Postoperatively, transient hypoxia (25% cases) was observed during the first 3 h. Analgesia duration was in the 40-1440 min range. Hospital stay was 5.6 +/- 1.5 days (mean +/- SD). Laparoscopic paediatric fundoplication is safe when hypovolaemia and postoperative hypoxia are prevented.