Comparative study of respiratory and hemodynamic effects of thoracoscopy versus laparoscopy for repair of congenital diaphragmatic hernias in neonates and infants

The use of minimally invasive surgery has been expanding steadily in pediatric surgical practice. Thoracoscopy and laparoscopy have been used for correction of congenital diaphragmatic defects in neonates and in young children. This study aimed at comparing cardiorespiratory effects of both techniques when used for the repair of congenital diaphragmatic hernias. From January 2007 to December 2007, 20 neonates and young infants were enrolled in the study. Children were all ASA II and III their age ranged from 0-6 months and their mean weight was 4485g. ETCO2, O2 saturation, HR and MAP were recorded at basleine [before insufflation], at 30, 60 minutes after insufflation and 10 minutes after desufflation, also minute volume and peak inspiratory pressure were recorded before and after insufflation. The operative time was also recorded and compared in both groups. The mean operative time was 116 +/- 9.3 minutes for thoracoscopy and 152 +/- 12.5 minutes for laparoscopy p<0.05. O2 saturation decreased from 99.4% +/- 1.3 to 96.1 +/- 4.8 p<0.05 and from 99.2 +/- 1.6 to 95.8 +/- 4.8 p<0.05 in the laparoscopic and thoracoscopic groups respectively. ETCO2 increased from 28.2 +/- 5.4 to 36.1 +/- 6.9 mmHg p<0.05 and from 27.4 +/- 6.5 to 39.8 +/- 4.2 mmHg p<0.05 in the laparoscopic and thoracoscopic groups respectively. The duration of insufflation influenced the increase in ETCO2, as values of ETCO2 recorded after one hour showed the greatest values [39.2 +/- 5.3 and 40.3 +/- 3.9 in the laparoscopic and thoracoscopic groups respectively all patients showed increase in HR from 119 +/- 12.7 to 134 +/- 17.2 heats/minute p<0.05 and from 121 +/- 11.9 to 138 +/- 14.7 heats/minute p<0.05 in the laparoscopic and thoracoscopic groups respectively after CO2 insufflation, in 90% of cases the MAP was stable during CO2 insufflation. In conclusion, this study demonstrated comparable cardiorespiratory effects of thoracoscopy and laparoscopy-within the mentioned insufflation pressure in the study- for repair of CDH in neonates and young infants nevertheless thoracoscopy could be performed in a significantly shorter time

Dexmedetomidine as an adjunct to combined general and caudal anesthesia in children undergoing open reduction for congenital hip dislocation

We tested dexmedetomidine [DEX], and alpha 2 agonist for its ability to prolong the duration of analgesia after single shot caudal block, to provide stable haemodynamics and to optimize surgical field in pediatric patient undergoing open reduction for developmental dysplasia of the hip. In a randomized, placebo controlled study, 40 patients were randomly assigned to one of two equal groups. The Dex group received 0.5 micro g/kg/h dexmedetomidine and the control group received normal saline. Mean arterial pressure, heart rate, average category scale for quality of surgical field, intraoperative inspired sevoflurane concentartion and time to first rescue analgesia were measured. Relative to baseline and to the control group, mean arterial pressure and heart rate decreased significantly 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 180 minutes after start of dexmedetomidine infusion p<0.05. The average category scale for the quality of surgical field was significantly lower at 15, 30, 60, 90 and 120 minutes in the dexmedetomidine group compared to the control group p<0.05. The inspired sevoflurane concentration was significantly less in the dexmedelomidine group compared to the control group [1.46 +/- 0.7% Vs 2.07 +/- 0.18% respectively] p<0.05 and the time to the first rescue analgesia was significantly prolonged in the dexmedetomidine group compared to the control group [11.2 +/- 3.9h Vs 7.9 +/- 4.6h] respectively p<0.05. In conclusion, intraoperative dexmedetomidine infusion prolonded the duration of analgesia after single shot caudal ropivacaine, provided stable haemodynamics, better surgical field and decreased the intraoperative inspired sevoflurane concentration