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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
PEDIATRIC ORIGINAL ARTICLES
Minerva Anestesiologica 2007 Marzo;73(3):161-71
Thoracoscopy in children: anaesthesiological implications and case reports
Gentili A. 1, Lima M. 2, De Rose R. 1, Pigna A. 1, Codeluppi V. 1, Baroncini S. 1
1 Department of Anestesia, and Intensive Care Antalgic Therapy, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy;
2 Department of Obstetrics, Gynecology and Pediatrics, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
Aim. Videoassisted thoracic surgical technique in children is being used with increasing frequency for an extensive variety of diagnostic and therapeutic procedures. The aim of the study was to assess respiratory, cardiocirculatory and body temperature changes in children undergoing thoracoscopy and to identify if the trend of such changes was modifiable by factors such as lung exclusion, length of the thoracoscopy and preoperative respiratory compromise.
Methods. A total of 50 patients (38 boys and 12 girls) undergoing general anaesthesia for diagnostic and therapeutic thoracoscopic procedures were analysed. The values of the monitored parameters were compared at 6 specific times: T1 - at the end of anaesthesia induction (considered the basal level); T2 - after lateral position; T3 - before pleural CO2 insufflation; T4 - 10 min after pleural CO2 insufflation; T5 - before pleural deflation; T6 - 10 min after pleural deflation.
Results. All patients tolerated the thoracoscopy well, without intraoperative complications. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower, and end-tidal CO2 (PETCO2) significantly higher during thoracoscopy. Body temperature (BT) had a statistically significant reduction during thoracoscopy and after pleural deflation. During one-lung ventilation the PETCO2 increased compared to two-lung ventilation with intrapleural insufflation, while during two-lung ventilation with intrapleural insufflation SBP and DBP decreased compared to one-lung ventilation. The length of the thoracoscopy increased the PETCO2 and reduced the BT. The preoperative respiratory compromise increased the PETCO2.
Conclusion. Although thoracoscopy in children brings about certain respiratory, cardiocirculatory and body temperature changes, it is nevertheless a safe and efficient surgical technique.