Minimally Invasive Surgery and Anaesthesia in Pediatrics

Overview

Objective:
To assess changes in ventilatory parameters, lung mechanics, cardiovascular stability and body temperature during laparoscopicprocedures especially in children of low body weight.Type of study: Prospective observational study.Setting: ARO and COS, University Teaching Hospital Brno, Children Hospital.Patients: 40 children (26 boys, 14 girls) scheduled for laparoscopic surgery. Mean age 69.55 months (1 month to 18 years of age), mean body weight23.93 kilograms; mean ASA grade 1.85.Method: Patients received routine oral premedication one hour before surgery (or were premedicated intramuscularly 30 mins prior to surgery).Anaesthesia was maintained with infusion of alfentanil (Rapifen) or fentanyl boluses with low dose isoflurane. Muscle relaxation was achieved byatracurium (Tracrium) or vecuronium (Norcuron).Patients were mechanically ventilated in volume control mode. Parameters of ventilation were adjusted according to continuously monitored CO2in exhaled gas mixture (EtCO2). We recorded ventilator settings and lung mechanics characteristics (tidal volume, frequency, minute ventilation,airway pressures, compliance and EtCO2), cardiovascular parameters and body temperature. Blood saturation was monitored by pulse oximeterperipherally (SpO2) on both upper and lower parts of the body. We recorded the parameters after the induction to anaesthesia, after insufflation ofperitoneal cavity and after desufflation. The results were compared using paired t-test.Results: The mean duration of the procedure was 57 minutes. Mean capnoperitoneum time was 44 minutes. Mean general anaesthesia duration was85.2 minutes.After CO2 insufflation, minute ventilation was increased (RR 21.00/min vs 23.73/min, p

Key words:
capnoperitoneum – ventilatory parameters – lung mechanics – cardiovascular stability – body temperature – children