Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

Background: The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO₂) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients. Patients and Methods: Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO₂), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO₂insufflation induced pneumoperitoneum (PP) (T2); CO₂PP insufflation (T3); cessation of CO₂PP (T4); before extubation (T5). Results: rScO₂decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO₂decreased 3.6 ± 0.38%); restoration of rScO₂was achieved after PP cessation (P = 0.007). The changes in rScO₂were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO₂flow rate (P = 0.001). No significant peripheral effects were noted. Conclusions: The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.