title: Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair.
abstract: BACKGROUND
  The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients.
  
  
  METHODS
  Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2insufflation induced pneumoperitoneum (PP) (T2); CO2PP insufflation (T3); cessation of CO2PP (T4); before extubation (T5).
  
  
  RESULTS
  rScO2decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2decreased 3.6 ± 0.38%); restoration of rScO2was achieved after PP cessation (P = 0.007). The changes in rScO2were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2flow rate (P = 0.001). No significant peripheral effects were noted.
  
  
  CONCLUSIONS
  The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.
authors.affiliation: Department of Maternal and Child Health, Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.affiliation: Department of Internal Medicine, University of Pavia, Pavia, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Bernardi
authors.affiliation: Department of Maternal and Child Health, Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Carlini
authors.affiliation: Department of Maternal and Child Health, Pediatric Surgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
authors.forename: Noemi
authors.initials: N
authors.lastname: Pasqua
authors.affiliation: Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Mencherini
authors.affiliation: Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maggio
authors.affiliation: Biometry and Clinical Epidemiology, Scientific Direction, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Department of Internal Medicine, University of Pavia, Pavia, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Bianchi
authors.affiliation: Department of Internal Medicine, University of Pavia; Department of Maternal and Children's Health, Pediatric Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra