title: A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy.
abstract: BACKGROUND
  This study was designed to determine whether a decrease in renal oxygenation occurs during CO2 pneumoperitoneum in children with normal renal function undergoing laparoscopy.
  
  
  METHODS
  Near infrared spectroscopy (NIRS) probes were applied to both the lateral flank (T10-L2) and lateral cerebral area of all patients with normal renal function undergoing a laparoscopic procedure. Information was recorded in 5-s intervals for 15-min before, during, and for 15-min after pneumoperitoneum insufflation and desufflation. Simultaneously, additional hemodynamic parameters (arterial saturation, mean arterial pressure, end tidal CO2, and urine output) were recorded every 5-min. Pneumoperitoneum pressures used were: 0-1 month old, <6 mmHg; 2-12 months old, <8 mmHg; 1-2 years old, <10 mmHg, and 2-8 years old, <12 mmHg. The lowest possible pressure was used to obtain adequate vision.
  
  
  RESULTS
  Twenty-nine patients were enrolled in the study. Renal regional oxygen saturation (rSO2) did not decrease significantly between baseline (preinsufflation), insufflation, and desufflation of the pneumoperitoneum (p = 0.343). Meta-analysis of this data demonstrated a pooled weighted difference of -1.4 (-3.5 to 0.54), confirming no significant change. A significant increase in cerebral rSO2 occurred during the insufflation period of the CO2 pneumoperitoneum (p = 0.001). Heart rate (F = 11.05; p < 0.001) and mean arterial pressure (MAP) (F = 19.2; p < 0.001) also increased significantly during the laparoscopy. No significant correlation was identified between fluid input and urine output during the laparoscopy (r = 0.012; p = 0.953).
  
  
  CONCLUSIONS
  Renal hypoxia does not occur during laparoscopic surgery in children if the minimum age-appropriate intra-abdominal pressures are used. Alternative causes must account for the oliguria and anuria demonstrated in children undergoing laparoscopy.
authors.affiliation: Department of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Rondebosch, 7700, Cape Town, South Africa, drcwtaylor@gmail.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Westgarth-Taylor
authors.forename: Leonnie
authors.initials: L
authors.lastname: de Lijster
authors.forename: Guido
authors.initials: G
authors.lastname: van Bogerijen
authors.forename: Alastair J W
authors.initials: AJ
authors.lastname: Millar
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karpelowsky
mesh_terms: D001002:Anuria / Q000097:blood / Q000209:etiology; D001785:Blood Gas Monitoring, Transcutaneous; D001921:Brain / Q000378:metabolism; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D002534:Hypoxia, Brain / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000097:blood / Q000209:etiology; D007668:Kidney / Q000098:blood supply / Q000378:metabolism*; D010535:Laparoscopy; D008297:Male; D009846:Oliguria / Q000097:blood / Q000209:etiology; D009928:Organ Specificity; D010108:Oxyhemoglobins / Q000032:analysis; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D012079:Renal Circulation; D019265:Spectroscopy, Near-Infrared
chemical_list: D010108:Oxyhemoglobins; D002245:Carbon Dioxide