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 ORIGINAL ARTICLE
Year : 2017  |  Volume : 13  |  Issue : 1  |  Page : 51-56

Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair


1 Department of Maternal and Child Health, Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
2 Department of Internal Medicine, University of Pavia, Pavia, Italy
3 Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
4 Biometry and Clinical Epidemiology, Scientific Direction, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
5 Department of Internal Medicine, University of Pavia; Department of Maternal and Children's Health, Pediatric Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

Correspondence Address:
Gloria Pelizzo
Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, P.le Golgi n. 2, 27100 Pavia
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.181800

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Background: The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients. Patients and Methods: Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2insufflation induced pneumoperitoneum (PP) (T2); CO2PP insufflation (T3); cessation of CO2PP (T4); before extubation (T5). Results: rScO2decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2decreased 3.6 ± 0.38%); restoration of rScO2was achieved after PP cessation (P = 0.007). The changes in rScO2were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2flow rate (P = 0.001). No significant peripheral effects were noted. Conclusions: The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.






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