Tolerance of Laparoscopy and Thoracoscopy in Neonates

Abstract

ABSTRACT. Objectives. Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of videosurgery in neonates and to determine the risk factors of per-operative complications.Methods. From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula.Results. Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6°C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O 2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO 2 , surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation.Conclusion. The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. ABBREVIATIONS. ETCO 2 , end-tidal pressure of CO 2 ; O 2 sat, oxygen saturation; HR, heart rate; PIP, peak inflating pressure.

Multicentric assessment of the safety of neonatal videosurgery

“…On the basis of our preliminary work [15], we conducted a multicentric study to evaluate the safety and complication rate of laparoscopy and thoracoscopy during the first month of life based on the experience of eight pediatric surgery centers to determine the risk factors for perioperative complications, to reduce their occurrence, and to describe the recent trends in videosurgical practice.…”

Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs

“…However, the limited data available regarding the potential deleterious effects of the CO 2 PP for this age group points toward an increased sensitivity to long-lasting laparoscopies [4,7,8,16]. In adult patients, a long-lasting CO 2 PP limited to a maximum pressure of 12 mmHg is widely used [5].…”

“…Clinical data point toward an increased sensitivity of neonates [7,8,16]. Kalfa et al [8] reported on 26 anesthetic incidents among 204 neonates (mean age, 16 days; weight, 3.4 kg) related to CO 2 insufflation.…”

Endosurgical treatment of diaphragmatic diseases in infants

“…Однако сторонники минимально инвазивных операций всерьез дискутируют о без-опасности торакоскопии, так как использование карботоракса связано с некоторыми осложнения-ми, такими как дыхательный ацидоз, гиперкарбия, легочная гипертония [15,25], и его воздействие на новорожденного во время торакоскопии все еще остается неопределенным. Экспериментальная ра-бота G. Stratmann [26] и клиническое исследование M. Bishay [27] показали, что карботоракс ассоцииру-ется со значительным интраоперационным ацидо-зом, который может приводить к нейросенсорному поражению.…”