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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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ANESTHESIA IN PEDIATRICS  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 May;68(5):406-13

language: English

Anaesthesia for laparoscopic surgery in paediatrics

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.

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