Document Detail

Tolerance of laparoscopy and thoracoscopy in neonates.
MedLine Citation:
PMID:  16322135     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of video-surgery in neonates and to determine the risk factors of per-operative complications. METHODS: From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula. RESULTS: Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6 degrees C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO2, surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation. CONCLUSION: The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. The described profile of the neonate at risk may help to reduce the frequency of adverse effects of this technique and improve its tolerance.
Nicolas Kalfa; Hossein Allal; Olivier Raux; Manuel Lopez; Dominique Forgues; Marie-Pierre Guibal; Jean-Charles Picaud; Ren?-Benoit Galifer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  116     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-02     Completed Date:  2005-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e785-91     Citation Subset:  AIM; IM    
D?partement de Chirurgie Visc?rale P?diatrique, H?pital Lapeyronie, CHU Montpellier, France.
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MeSH Terms
Blood Pressure
Body Temperature
Heart Rate
Infant, Newborn
Risk Factors
Video-Assisted Surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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