Haemodynamic and cerebral oxygenation during paediatric laparoscopy in fluid optimized patients

Abstract

No difficulties were encountered in children's hospitals regarding equipment and assistance for paediatric emergency surgery. The principal finding of the present survey was that 77.1% of respondents from DGHs and university hospitals encountered difficulties, either related to a lack of specialized personnel (67.7%) or because of a lack of age-appropriate equipment (9.4%), when carrying out emergency surgery for children (Fig. 1). Only 27.1% had a 24 h cover for paediatric emergency surgery. Half of all paediatric emergency procedures are carried out by the general surgeon and the anaesthetist on duty. Only 27.6% responded that they had a dedicated, specialized paediatric team. Two out of every 10 children admitted for emergency surgery would be transferred to a specialist paediatric centre. Local hospital guidelines standardizing paediatric emergency procedures were missing in 77.9% of DGHs and university hospitals. Half of the respondents (46.1%) reported having a lower limit for age or weight, or both in children undergoing elective surgery during the daytime. Regarding basic airway equipment, such as laryngeal masks, tracheal tubes of paediatric and neonatal sizes, Guedel airways, and facemasks, these were available in the majority of hospitals Declaration of interest None declared.

Pediatric Laparoscopy and Adaptive Oxygenation and Hemodynamic Changes

“…To date, its effects on systemic and cerebral oxygenation have not been completely investigated 1-3 and the exact effects of surgical maneuvers in combination with conventional anesthesiological procedures in hemodynamic regulation are still debated. Hemodynamic alterations, associated with abdominal laparoscopy are mainly caused by the increased intra-abdominal pressure (IAP), brought on by pneumoperitoneum (PP) creation.…”

Effects of Carbon Dioxide Insufflation and Trendelenburg Position on Brain Oxygenation During Laparoscopy in Children

“…Maesani and colleagues evaluated standard ventilation parameters, hemodynamic parameters, cardiac index, stroke volume, and cerebral oxygen saturation in their study and found that CO 2 pneumoperitoneum with 10 to 15 mm Hg IAP has minimal effect on cardiac output and cerebral oxygenation in children between 6 and 168 months. 27 We also think that the stability of the MAP values in our study is because of received IV fluid treatment after fasting until the operation and the maintenance treatment during the operation. Therefore, we recommended that the patients must be well hydrated throughout the procedure.…”

“…24,25 Reports on the practice of NIRS at laparoscopic surgery in children and newborns are also growing in the last decades. 26,27 As a first in the literature, we investigated the effects of CO 2 pneumoperitoneum and Trendelenburg position using NIRS on hemodynamic parameters and cerebral oxygenation in children undergoing laparoscopic appendectomy.…”

Neurodevelopment impact of CO2-pneumoperitoneum in neonates: experimental study in a rat model

“…6,7 But concerns have also been extended to the type of surgical approach applied in this population, 8 with the minimally invasive approaches and the neurodevelopmental impact of peritoneal CO 2 -insufflation, focus of numerous recent publications. [9][10][11][12] Since many questions are still without clear answers, any finding on the isolated effects of these surgicalrelated events will result in critical changes in neonatal medical practice. Therefore, additional preclinical and clinical research on anesthesia, mechanical ventilation, postoperative care, and the surgery itself are needed.…”