Haemodynamic changes and ventilatory effects of spontaneous ventilation during short laparoscopic procedure in children

Anaesthesia for laparoscopy is a controversial subject and the introduction of laryngeal mask offers an alternative to enventional methods of airway management during laparoscopy. This study prospectively evaluated the cardiorespiratory changes during general anesthesia using the laryngeal mask with spontaneous ventilation during short diagnostic laparoscopic inspection of the peritoneum in children. Anesthesia consisted of sevoflurane in 50% oxygen/air and caudal epidural block. The patient was allowed to ventilate spontaneously without assistance. Baseline measurements of heart rate, systolic blood pressure [SBP], end-tidal CO[2] [ETCO[2]], tidal volume, respiratory rate, and oxygen saturation were recorded every 1 min for 5 min prior to the start of laparoscopy and every minute during the laparoscopic procedure. 15 patients were included in the study ranging in age from 5-8 years [6.57 +/- 1.43] and in weight from 18.3-29 kg [23.2 +/- 4.79]. The duration of the laparoscopy varied from 6 to 20 min [13.4 +/- 6.6 min]. HR was insignificantly increased from a baseline value of 139 +/- 8 to 145 +/- 5 beats/min [P = 0.0016] and in the [systolic blood pressure] SBP from a baseline value of 92 +/- 4 mm Hg to 95 +/- 8 mm Hg [P = 0.0087]. The baseline tidal volume prior to the start of laparoscopy was 5.6 +/- 1.1 mL/kg and increased to 7.0 +/- 1.5 mL/kg during laparoscopy [p<0.0001] while the respiratory rate increased from 31 +/- 7 to 43 +/- 3 breaths/min [p<0.0001]. ETCO[2] increased from a baseline value of 48 +/- 5 to 54 +/- 3 mmHg [p = 0.0059]. The maximum value of the ETCO[2] was 56 mmHg or greater in 4 patients, exceeded 60 mmHg in 1 patients, with a maximum value of 61 mmHg. The increased ETCO[2] returned to baseline within 3 to 9 min [6.6 +/- 2.4 min] following completion of the laparoscopy. There was no significant change in oxygen saturation, no episodes of clinical aspiration occurred and no pri-operative arrhythmias. The present study demonstrates that LMA anaesthesia can be used for spontaneous breathing during short diagnostic laparoscopic procedures in children