Changes in cerebral and renal oxygenation during laparoscopic pyloromyotomy

Abstract

Although a laparoscopic approach may be preferred over open procedures for abdominal surgery, there are limited data on the effect of laparoscopic procedures on cerebral and renal oxygenation in neonates and young infants. Here, we evaluated the effect in neonates and infants. In this two-center prospective observational study, we evaluated changes in cerebral and renal regional oxygen saturation (rSO2) in infants during laparoscopic pyloromyotomy. Intraoperative hemodynamic and respiratory parameters and rSO2 were recorded. For the primary outcome, these parameters were compared at incision and at the end of pneumoperitoneum. The study cohort included 25 infants with a mean age of 40 ± 10days and weight of 4.0 ± 0.6kg. IAP at the beginning of laparoscopy was 10 ± 2mmHg (range 7-15mmHg). Although both cerebral and renal rSO2 decreased from incision compared to the end of laparoscopy, the decrease reached statistical significance only for cerebral rSO2 (81 ± 12 to 76 ± 16, p = 0.033). Similarly, the increase in fractional tissue oxygen extraction (FTOE) was only statistically significant for cerebral FTOE (0.18 ± 0.12 to 0.23 ± 0.16, p = 0.037). No change in hemodynamic or respiratory parameters was found. Although there was a decrease in cerebral rSO2 and increase in cerebral FTOE during pneumoperitoneum, the values did not decrease below those noted before anesthetic induction.