Anesthetic Management of Laparoscopic Surgery for Infants and Children

Abstract

The evolution of technology has made great advances in laparoscopic surgery. It can be said that most types of abdominal surgery in pediatrics are attempted under laparoscopy. The anesthesia management of laparoscopic surgery in infants and children has unique features and potential pitfalls. Anesthesiologists should be familiar with the varieties of physiological changes in laparoscopic surgery, mainly resulting from increased intra-abdominal pressure by insufflated CO2, increased absorption of CO2, and patient positioning. Anesthetic management depends on each patient's clinical condition. Except for short diagnostic laparoscopy, patients are usually paralyzed with muscle relaxant and intubated. The cuffed endotracheal tube can be carefully used for effective positive pressure ventilation. Ventilatory strategy might be readjusted during pneumoperitonium. Anesthesiologists should also pay attention to intra-abdominal pressure because high pressure (>15 mmHg) will cause serious problems. Complications include difficulties in surgical techniques and problems related to pneumoperitoneum. The complication rate is known to largely depend on the surgeon's skill and experience.