Anesthesia During Pediatric Laparoscopy: Are There Changes Related to the Intra-abdominal Pressure and the Duration of Peritoneal Insufflation?

Abstract

ABSTRACT

The authors examined global trends of the main vital parameters in 154 children (mean age 6.7 ± 6.4 years, mean weight 24.8 ± 16 kg) undergoing laparoscopic surgery, to determine whether intra-abdominal insufflation can determine modifications in principal parameters on the basis of the length of its duration (over or under 60 min). Intra-abdominal pressure (IAP) was always kept below 12 mm Hg. Measurements of heart rate (HR); systolic blood pressure (SBP); diastolic blood pressure (DBP); arterial oxygen saturation (SpO₂); end-tidal CO₂ (PETCO₂); peak, plateau and mean airway pressure; and body temperature were recorded five times: at the end of anesthesia induction, before CO₂ insufflation, 10 min after CO₂ insufflation, before deflation, and 10 min after deflation. The HR remained constantly regular. The SBP and DBP, compared with values at the end of induction (SBP = 98±14 mm Hg, DBP = 51±10 mm Hg), increased (p<0.001) in the two determinations during intra-abdominal insufflation (SBP = 104 ±16 and 106±16 mm Hg, DBP = 56±13 and 57±12 mm Hg). There was no change in SpO₂. PETCO₂ increased (p<0.001) from a baseline value of 33.1±3.2 mm Hg to 38.2±3.2 and 38.6±3.5 mm Hg during the pneumoperitoneum. Peak, plateau, and mean airway pressures increased during intra-abdominal insufflation. No relevant differences of those parameters could be observed between the two groups divided according to the length of the intra-abdominal insufflation. This experience suggests that in children undergoing laparoscopic surgery, modifications in principal parameters are influenced by the increase in IAP, not by its duration.