Hemodynamic and respiratory effects of robot-assisted laparoscopic fundoplication in children

Laparoseopic fundoplication is increasingly used for treating gastro-esophageal reflux disease in children. Mechanical and pharmacological effects may contribute to hemodynamic and respiratory changes during carbon dioxide pneumoperitoneum. The aim of the present study was to evaluate the hemodynamic and respiratory effects of pneumoperitoneum (PP) with an intra-abdominal pressure (IAP) of 12 mmHg in children undergoing robot-assisted laparoscopic fundoplication during total intravenous anesthesia. Ten children, aged 8-16 years, American Society of Anesthesiologists physical status II-III, scheduled for robotassisted laparoscopic fundoplication in the reverse Trendelenburg position were investigated. Minute ventilation (MV), peak inspiratory pressure (PIP), LAP, heart rate (HR), mean arterial blood pressure (MAP) were recorded, together with pH, base excess, HCO3-, PetCO2, PaCO2, and PaO2 at six time points: before insufflation, 10, 30, 60, 90 minutes after creating PP and after desufflation. The LAP was maintained at 12 mmHg. During insufflation MAP increased significantly from 70.6 (+/- 9.0) to 84.8 (+/- 10.4) mmHg, MV was increased from 4.6 (+/- 0.8) to 5.5 (+/- 0.9) lmin(-1), PIP increased, PaO2 and pH decreased. PetCO2 increased from 33.1 (+/- 1.6) to 36.6 (+/- 1.6) mmHg together with PetCO2. Hemodynamic and respiratory effects due to the intra-abdominal insufflation of CO2 with an IAP of 12 mmHg are well tolerated, and anesthesia with remifentanil, propofol and mivacurium facilitates extubation immediately at the end of surgery.