Laparoscopy in infants: close intraoperative hemodynamic monitoring for patient safety

Background Hemodynamic changes during laparoscopy have not been well de ned in very young children. In this study, intraoperative monitoring of hemodynamic parameters and oxygenation was evaluated during laparoscopy in infants weigh- ing < 10 kg. Patientsandmethods Thirtyinfants(5.07±2.51kg),undergoinglaparoscopy(LAPGroup,n=15)oropensurgery(Open Group, n = 15), were enrolled. Cerebral regional (crScO2), renal regional oxygenation (rrScO2), peripheral oxygen satura- tion (SpO2), heart rate (HR), blood pressure, transcutaneous CO2 (TcCO2), end-tidal CO2 (EtCO2), and core temperature (TC) were analyzed at ve intervals: T0 = basal; T1 = anesthesia induction; T2 = CO2 PP insu ation in the LAP group; T3 = intraoperative; T4 = cessation of CO2 PP in the LAP group; and T5 = before extubation. Results The LAP group showed di erences 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 TcCO2 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 di erent during lapa- roscopy; on the contrary, the OPEN group exhibited a decrease in SpO2 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 signi cant variations were recorded in blood pressure or end-tidal CO2. Conclusion Limited e ects on oxygenation, cardiac output, and thermoregulation were detected in infants during laparoscopy. Many factors, including the child’s age, may play di erent roles in the regulation of these parameters. Close monitoring is essential to guarantee the infant’s safety.