Abstract
Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.
Highlights
Nowadays, laparoscopic surgery has become a worldwide common daily-performed procedure in pediatric patients (Gupta & Singh, 2009)
The blood pressures of patients (SBP and diastolic blood pressure (DBP)), the PaCO2 and stroke volume (SV) were measured during the operation at stages of T0, T1,T2, T3
When intraabdominal pressure (IAP) was more than 10 mmHg, a tendency could be observed that the risk ratio (RR) elevated with the increase of IAP
Summary
Laparoscopic surgery has become a worldwide common daily-performed procedure in pediatric patients (Gupta & Singh, 2009). The pathophysiological disturbances induced by CO2 insufflation or pneumoperitoneum were reviewed in a previous study (Hackam & Rotstein, 1998). IAP level of 12 mmHg has been reported to be associated with decreased cardiac index and hypokinesis of left ventricular in children (Sakka et al, 2000). Some other factors such as duration of surgery, position of patients, etc. We tried to find an optimal IAP level which provided enough visual space and induced fewer complications in pediatric laparoscopic surgeries
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