Laparoscopy in infants: close intraoperative hemodynamic monitoring for patient safety

Pelizzo, Gloria; Puglisi, Aurora; Mitri, Marco Di; Silvestri, Annalisa De; Mura, Giovanni Battista; Amoroso, Salvatore; Pollicino, Roberto; Calcaterra, Valeria

doi:10.1007/s42804-019-00004-1

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…Therefore, maintaining normocapnia and avoiding hypercapnia is very important in high‐risk patients during airway management and mechanical ventilation because the resulting elevated ICP can further decrease cerebral perfusion pressure and cerebral oxygenation. Recently, laparoscopy and thoracoscopy are common in the pediatric population including neonates and infants 7 . Insufflation of carbon dioxide increases the intraabdominal and intrathoracic pressure, reduces lung compliance, and leading to hypercapnia.…”

Section: Discussionmentioning

confidence: 99%

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Effect of end‐tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial

Jang

Nam

et al. 2022

Pediatric Anesthesia

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Background: Intraoperative hypercapnia and hypocapnia are common during pediatric anesthesia, and the cerebral blood flow and intracranial pressure may be affected by the partial pressure of arterial carbon dioxide. Transorbital ultrasound measurement of the optic nerve sheath diameter is a simple and non-invasive method for intracranial pressure assessment. The objective of this study was to evaluate the effect of end-tidal carbon dioxide (E T CO 2 ) on optic nerve sheath diameter in a healthy anesthetized pediatric population. Methods: Pediatric patients scheduled for elective surgery under general anesthesia and mechanical ventilation in the supine position were enrolled and divided into four subgroups; age <2 years, 2-6 years, 6-12 years, and 12-18 years. Mechanical ventilation was adjusted to achieve target E T CO 2 levels in a randomized sequence (40-35-45-40 mmHg or 40-45-35-40 mmHg). Three minutes after reaching each target E T CO 2 level, transorbital ultrasound images of optic nerve sheath diameter were obtained and analyzed.The primary outcome was the optic nerve sheath diameter at each E T CO 2 level.Results: Sixty-four pediatric patients were enrolled and analyzed. At E T CO 2 = 40 mmHg, the optic nerve sheath diameter was 5.6 ± 0.6 mm, 6.4 ± 0.5 mm, 6.8 ± 0.6 mm, and 7.1 ± 0.5 mm in children aged <2 years, 2-6 years, 6-12 years, and 12-18 years, respectively. The overall percent decreases in the optic nerve sheath diameter was −5.6 ± −4.3% (95% CI; −6.7 to −4.5%) at E T CO 2 = 35 mmHg while the overall percent increases of optic nerve sheath diameter (ONSD) was 4.9 ± 5.1% (95% CI; 3.6 to 6.1%) at E T CO 2 = 45 mmHg compared with those at E T CO 2 = 40 mmHg. Spearman rank correlation analysis indicated that there were weak to moderate correlation between E T CO 2 and the optic nerve sheath diameter (correlation coefficient [p-value] = .355 [.004], .318 [.014], .373 [<.001], and .420 [<.001] in children aged <2 years, 2-6 years, 6-12 years, and 12-18 years, respectively). Conclusions: The optic nerve sheath diameter measured by transorbital ultrasound showed rapid reactivity from E T CO 2 35 to 45 mmHg in healthy pediatric patients under inhalation general anesthesia. How to cite this article: Jang Y-E, Nam SP, Ji S-H, et al. Effect of end-tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial. Pediatr

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Section: Discussionmentioning

confidence: 99%

“…In pediatric anesthesia, brief hypercapnia and hypocapnia are common. [3][4][5][6][7][8] Nevertheless, the effect of transient mild hypercapnia and hypocapnia on the ICP in pediatric patients during inhalation anesthesia is not well investigated.…”

Section: Introductionmentioning

confidence: 99%

Effect of end‐tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial

Jang

Nam

et al. 2022

Pediatric Anesthesia

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“…When conducting exploration using laparoscopy in pediatric patients, one of the things to note is intra-abdominal pressure. In these case, an intra-abdominal pressure regulation of 8 mmHg was used (Pelizzo et al, 2019). In adult patients, the standard intra-abdominal pressure is set at 12-14 mmHg (Kanwer et al, n.d.).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Shunt Extraction in Children Using Laparoscopy: A Case Report

Rahardjo¹,

Hermawan²,

Wijayanti³

2022

J.Ilm.Kedokt. Wijaya Kusuma

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Laparoscopy is one way to perform various simple procedures or surgeries in the abdominal cavity. Laparoscopy can be useful in the management of ventriculo-peritoneal shunt (VP Shunt) fractures. The peritoneal component of the shunt remaining in the abdominal cavity can be removed using laparoscopy. A pediatric patient with hydrocephalus with a history of VP Shunt insertion 5 years ago, came with complaints of weakness, vomiting and difficulty eating. Physical examination revealed the presence of edema in the chamber area. A CT scan of the head and plain abdominal radiographs were performed. The diagnosis was made as a shunt fracture, with the peritoneal component of the shunt remaining in the abdominal cavity. The patient received treatment in the form of a revised VP shunt and peritoneal shunt extraction using standard laparoscopy which is commonly used for adult patients. The patient's condition improved after the procedure. Peritoneal shunt extraction in cases of VP shunt fracture can be safely performed using laparoscopy. If there are limited tools, this procedure can still be performed on children using standard laparoscopy which is usually used for adult patients. Authors report this case due to no previous report in Mojokerto area were known.

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“…[4] However, laparoscopy is associated with its own limitations in paediatric patients, owing to crowding of viscera in small space, restricted access of periumbilical area for port, hemodynamic alterations, raised intraabdominal pressure and an alteration in arterial blood gas following absorption of carbon dioxide and circulatory pressure changes. [12] This was an observational comparative study involving two groups of paediatric patients undergoing elective abdominal surgery either laparoscopically or by a conventional open abdominal approach. The study focused on observing changes in heart rate, blood pressure, end tidal carbon-di-oxide, PvCO2 and pH during the intra-operative period.…”

Section: Discssionmentioning

confidence: 99%

A Comparative Study: Haemodynamic Changes in Paediatric Laparoscopic Surgery

Tiwari¹

2019

jmscr

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The paediatric laparoscopic surgery has gained popularity due to reduced morbidity, mortality and health care costs. However, the intra-abdominal pressure (IAP) and higher vagal tone are critical determinants of cardiovascular stability and its anaesthetic management during laparoscopy. Paediatric laparoscopic procedures are likely to cause an increase in pulmonary and systemic vascular resistance, sudden bradycardia during pneumoperitoneum because peritoneal stimulation by a blast of insufflated gas or penetration by trocars and laparoscopes. The present study was designed to quantify the changes in haemodynamics and compare these with conventional abdominal surgery.

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Laparoscopy in infants: close intraoperative hemodynamic monitoring for patient safety

Cited by 3 publications

References 28 publications

Effect of end‐tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial

Effect of end‐tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial

Peritoneal Shunt Extraction in Children Using Laparoscopy: A Case Report

A Comparative Study: Haemodynamic Changes in Paediatric Laparoscopic Surgery

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