British Journal of Anaesthesia, Vol 84, Issue 3 330-334, Copyright © 2000 by Oxford University Press
SG Sakka, E Huettemann, G Petrat, A Meier-Hellmann, F Schier and K Reinhart
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.
ARTICLES
Transoesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children
Department of Anaesthesiology and Intensive Care Medicine, Friedrich- Schiller-University of Jena, Germany.
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