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Effects of Carbon Dioxide Insufflation and Trendelenburg Position on Brain Oxygenation During Laparoscopy in Children

Oztan, Mustafa O., MD*; Aydin, Gaye, MD; Cigsar, Emine B., MD; Sutas Bozkurt, Pervin, MD; Koyluoglu, Gokhan, MD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: April 2019 - Volume 29 - Issue 2 - p 90–94
doi: 10.1097/SLE.0000000000000593
Original Articles

Purpose: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children.

Methods: The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8).

Results: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group.

Conclusions: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.

*Department of Pediatric Surgery, Izmir Katip Celebi University, Cigli

Clinic of Anesthesiology and Reanimation

Clinic of Pediatric Surgery, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey

The authors declare no conflicts of interest.

Reprints: Mustafa O. Oztan, MD, Izmir Katip Celebi Universitesi, Katip Celebi Universitesi Dekanligi, Cocuk Cerrahisi Anabilim Dali, 35640 Cigli, Izmir, Turkey (e-mail:

Received July 4, 2018

Accepted October 2, 2018

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