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SMART 2002 Milan, May 29-31, 2002
ANESTHESIA IN PEDIATRICS
Baroncini S., Gentili A., Pigna A., Fae M., Tonini C., Tognù A.
From the Department of Anesthesia Resuscitation and Intensive and Analgesic Therapy Anesthesia and Resuscitation Unit-Baroncini S. Orsola-Malpighi Polyclinic University of Bologna, Bologna, Italy
Laparoscopic surgery is an emerging procedure in the treatment of many surgical pathologies. Laparoscopy in the paediatric patient reduces surgical trauma and improves cosmetic results. Physiological changes during laparoscopic surgery are mainly related to the increased intra-abdominal pressure (IAP) associated with CO2 insufflation of the abdomen, the patient’s postural modifications (head-up or head-down) and CO2 absorption and its general effects. Increases in IAP affect both ventilation and circulation. Increased IAP induces a mechanical compression of the diaphragm that reduces pulmonary compliance, vital capacity, functional residual capacity (FRC) and total lung volume. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The acute increase in IAP affects both preload and afterload, while the systolic cardiac performance remains unchanged. During anaesthesia for videolaparoscopy it is important not to exceed an intrabdominal pressure of 6 mmHg in newborns and infants and 12 mmHg in older children. In our clinical experience the respiratory, cardiocirculatory and temperature parameters have been slightly influenced during laparoscopy, but have always been maintained within the normal ranges. Laparoscopic videosurgery in newborns, infants and paediatric age group patients can be performed safely and with satisfactory clinical results.