Anaesthetic Considerations for Laparoscopic Procedures In Paediatrics
Sara Essam Mohammed El Bakry;
Abstract
Paediatric anaesthesia involves perioperative and critical care of patients of all ages ranging from preterm infants to teenagers. The differences in physiological characteristics makes anaesthetic management different and extremely challenging for the anaesthesiologist. It is imperative to have a good knowledge of the anatomic and physiologic difference between an adult and a paediatric patient for conduct of safe anaesthesia.
Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular. The anaesthetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult.
Laparoscopy offers the surgeon the option of achieving high standard surgical treatment while keeping tissue trauma to a minimum. Since the early 20th century, laparoscopic approach to surgical treatment has gained increasing popularity. However, the paediatric surgical subspecialty has lagged behind adult surgery in exploring the advances offered by laparoscopy. This is largely because some common conditions in adults like cholelithiasis which opened the gateway to the explosion in the application of laparoscopic surgery are uncommon in the paediatric age group. In addition, the low volume of corresponding conditions in the paediatric population has made it unattractive to companies involved in manufacturing and developing the paediatric laparoscopic equipment. For example, laparoscopic cholecystectomy which is a relatively non-complex procedure developed faster in the adult population than in children because of the lower case volume in the latter.
Several diagnostic and therapeutic procedures have been demonstrated to be safely and efficiently undertaken with laparoscopy with several advantages over traditional methods of approach. The development of 3mm instruments has pushed the boundaries of diagnostic, as well as therapeutic laparoscopy into the infant and neonatal population. In the investigation of the neonate with abdominal distension, free gas on plain abdominal radiograph in the absence of corresponding clinical or physiological signs of peritonism, laparoscopy has been used to evaluate the condition and arrive at more focused specific management decisions with improved outcome. In our experience an uncommon case of neonatal perforated appendicitis was diagnosed and treated at laparoscopy with quick recovery and discharge home within 48hours. Should the same neonate have had laparotomy for presumed bowel perforation from unknown cause with the consequent greater degree of bowel handling, resultant postoperative ileus and high doses of opiate, recovery would have been slower with longer duration of hospitalization.
Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular. The anaesthetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult.
Laparoscopy offers the surgeon the option of achieving high standard surgical treatment while keeping tissue trauma to a minimum. Since the early 20th century, laparoscopic approach to surgical treatment has gained increasing popularity. However, the paediatric surgical subspecialty has lagged behind adult surgery in exploring the advances offered by laparoscopy. This is largely because some common conditions in adults like cholelithiasis which opened the gateway to the explosion in the application of laparoscopic surgery are uncommon in the paediatric age group. In addition, the low volume of corresponding conditions in the paediatric population has made it unattractive to companies involved in manufacturing and developing the paediatric laparoscopic equipment. For example, laparoscopic cholecystectomy which is a relatively non-complex procedure developed faster in the adult population than in children because of the lower case volume in the latter.
Several diagnostic and therapeutic procedures have been demonstrated to be safely and efficiently undertaken with laparoscopy with several advantages over traditional methods of approach. The development of 3mm instruments has pushed the boundaries of diagnostic, as well as therapeutic laparoscopy into the infant and neonatal population. In the investigation of the neonate with abdominal distension, free gas on plain abdominal radiograph in the absence of corresponding clinical or physiological signs of peritonism, laparoscopy has been used to evaluate the condition and arrive at more focused specific management decisions with improved outcome. In our experience an uncommon case of neonatal perforated appendicitis was diagnosed and treated at laparoscopy with quick recovery and discharge home within 48hours. Should the same neonate have had laparotomy for presumed bowel perforation from unknown cause with the consequent greater degree of bowel handling, resultant postoperative ileus and high doses of opiate, recovery would have been slower with longer duration of hospitalization.
Other data
| Title | Anaesthetic Considerations for Laparoscopic Procedures In Paediatrics | Other Titles | الاعتبارات التخديرية لمناظير البطن الجراحية في الأطفال | Authors | Sara Essam Mohammed El Bakry | Issue Date | 2014 |
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