Understanding the physiological changes and potential complications associated with CO2 insufflation and positioning is essential for safe anesthesia in pediatric minimally invasive urological surgery.
Alerts clinicians to CO2 insufflation and positioning effects in pediatric urologic laparoscopy; leaves open evidence-based protocols pending prospective trials.
Laparoscopic or robotic minimally invasive approaches have become the standard of care for many urological pediatric surgical procedures. Anesthetic concerns for conventional and robotic laparoscopy are similar since they both require insufflations of CO 2 to allow visualization of surgical field and perform surgery. Even if required insufflation pressures and volumes are lower in pediatric patients (given the small size of the abdomen and laxity of the abdominal walls), the associated increase of intra-abdominal pressure, along with absorption of CO 2 and surgical positioning requirement, may result in neurendocrine and mechanical impact capable to mine cardiopulmonary function. Moreover, laparoscopic approach may require specific positioning. A correct positioning is essential to allow the surgical team to optimally and safely access to the patient. The knowledge of patient’s health status, along with the multiple physiologic changes that can occur and specific potential complications, allow the anesthesiologist to provide a safer an aesthesia.
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Spinelli et al. (2017) studied this question.
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