Abstract
ABSTRACT
The anesthetic and physiologic aspects of the authors' first 51 laparoscopic Nissen fundoplications are reviewed (age range 5 months to 20 years; weight 4.4–69 kg). Fourteen patients (27%) had associated severe respiratory disease, and 15 patients (29%) had feeding difficulties requiring additional gastrostomy formation. The median duration of anesthesia was 120 min (60–300). During the procedure, heart rate and blood pressure increased by 20% over baseline in 18% and 12% of cases, respectively. The median increase in Petco2 was 1.0 kPa (0.3–2.3). After surgery, all patients were cared for on a normal surgical ward except 1 patient with uncorrected congenital heart disease. Postoperative analgesia requirement was oral or rectal analgesics in most patients for 24–48 h. Perioperative complications occurred in 5 cases (10%); none was serious. The median postoperative hospital stay was 2 days (1–9). The authors conclude that laparoscopic fundoplication in children is well tolerated with minimal intraoperative physiologic disturbance. There is no requirement for routine postoperative high dependency or intensive care, and analgesic requirements are minimal.
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