Laparoscopy in infants: close intraoperative hemodynamic monitoring for patient safety

Abstract

Background  Hemodynamic changes during laparoscopy have not been well defined in very young children. In this study, intraoperative monitoring of hemodynamic parameters and oxygenation was evaluated during laparoscopy in infants weighing  10 kg. Patients and methods  Thirty infants (5.07 ± 2.51 kg), undergoing laparoscopy (LAP Group, n = 15) or open surgery (Open Group, n = 15), were enrolled. Cerebral regional ­(crScO2), renal regional oxygenation ­(rrScO2), peripheral oxygen saturation ­(SpO2), heart rate (HR), blood pressure, transcutaneous ­CO2 ­(TcCO2), end-tidal ­CO2 ­(EtCO2), and core temperature (TC) were analyzed at five intervals: T0 = basal; T1 = anesthesia induction; T2 = CO2 PP insufflation in the LAP group; T3 = intraoperative; T4 = cessation of ­CO2 PP in the LAP group; and T5 = before extubation. Results  The LAP group showed differences in ­crScO2 at T1, T3, and T4 compared with T0 (p  0.05) and in ­rrScO2 from T1 to T4 versus T0 (p  0.05), without hypoxemia. In addition, in the LAP group, an increase in T­ cCO2 from T2 to T5 versus T0 (p  0.01) was related to anesthesia time (p = 0.01) and sex (p = 0.03). The ­SpO2 values were not different during laparoscopy; on the contrary, the OPEN group exhibited a decrease in S­ pO2 at T4 (p  0.001) and an increase at T5 versus T0 (p = 0.001) compared with T0. HR and TC changes were detected in both groups (p  0.01). No significant variations were recorded in blood pressure or end-tidal ­CO2. Conclusion  Limited effects on oxygenation, cardiac output, and thermoregulation were detected in infants during laparoscopy. Many factors, including the child’s age, may play different roles in the regulation of these parameters. Close monitoring is essential to guarantee the infant’s safety.