Transoesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children

Abstract

Laparoscopic techniques for surgery are gradually becoming established in paediatric surgery. Technical aspects, such as the maximum safe gas insufflation pressure, are still open to discussion. We used transoesophageal echocardiography to study the haemodynamic changes in eight small children undergoing laparoscopic herniorrhaphy, with two different levels of intra-abdominal pressure (IAP), 6 and 12 mm Hg. End-tidal carbon dioxide tension was maintained constant at 4.3-4.7 kPa. After baseline measurements, an IAP of 12 mm Hg was applied for 10 min. Next, IAP was decreased to 6 mm Hg, followed by a second period of 12 mm Hg. Haemodynamic measurements were obtained at each stage. A further measurement was obtained 10 min after abdominal deflation at the end of surgery while anaesthesia was unchanged. Cardiac index (CI) decreased significantly only after the first 12 mm Hg level of IAP. The subsequent decrease in IAP to 6 mm Hg caused return of CI to baseline levels. The second increase in IAP did not cause any reduction in CI. The initial reduction in CI, although statistically significant, did not appear to be clinically important. We conclude that an IAP of up to 12 mm Hg appeared to be safe in healthy small children undergoing laparoscopic herniorrhaphy.

Anesthesiologic aspects of laparoscopic fundoplication for gastroesophageal reflux in children with chronic respiratory and gastroenterological symptoms

“…Rarely, invasive monitoring, such as the placement of an indwelling arterial catheter or a transesophageal color-Doppler probe, has been used to better evaluate cardio-respiratory changes in restricted series of highrisk patients [3,7,13,19].…”

Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome

“…It has been reported that the increase in abdominal pressure and Paco 2 from the carbon dioxide insufflation leads to an increase in peripheral vascular resistance and a decrease in cardiac index (CI) [4]. Sakka et al [1] used transesophageal echocardiography to demonstrate a 13% decrease in CI at 12 mm Hg intraabdominal pressure in healthy children aged 2 to 6 years. However, the CI returned to baseline with reduction of the intraabdominal pressure to 6 mm Hg, and neither pressure appeared to lead to clinically important changes in this patient population [1].…”

“…Sakka et al [1] used transesophageal echocardiography to demonstrate a 13% decrease in CI at 12 mm Hg intraabdominal pressure in healthy children aged 2 to 6 years. However, the CI returned to baseline with reduction of the intraabdominal pressure to 6 mm Hg, and neither pressure appeared to lead to clinically important changes in this patient population [1]. In addition, Gueugniaud et al [2] reported a 67% decrease in aortic blood flow indexed to body surface area and 162% increase in systemic vascular resistance indexed to body surface area compared with control values in a series of 12 ASA class 1 male patients aged 6 to 30 months with 10 mm Hg intraabdominal pressure.…”

“…It has been suggested that laparoscopy is contraindicated in these patients given the potentially deleterious hemodynamic effects of pneumoperitoneum on an already compromised cardiopulmonary system [1][2][3]. However, there are no published 0022-3468/$ -see front matter D 2007 Elsevier Inc. All reports of clinically adverse outcomes with pneumoperitoneum in patients with CCHD.…”

Laparoscopic surgery in children with congenital heart disease

“…For instance, many of these infants will have difficulties with failure to thrive or gastroesophageal reflux, requiring placement of a gastrostomy tube with or without a fundoplication. These procedures have been routinely performed laparoscopically in most children without cardiac disease with decreased infection and complication rates, as well as shorter hospital stays compared with the equivalent open procedures [1]. Patients with known congenital heart defects would certainly benefit from these aspects of laparoscopic surgery, but historically, these children were not commonly offered minimally invasive options because of the perceived cardiovascular risks associated with laparoscopy.…”