Evaluation of the effect of laparoscopic surgery on cerebral oxygenation with NIRS in pediatric patients

Aim: As a result of devoloping technology and increasing experience, laparoscopic surgery has become a technique that has gained a wide application area in the pediatric patient group as well as in adults. Laparoscopic surgery is performed with a technique called pneumoperitoneum, which is often performed with CO2 gas. Pneumoperitoneum increases the intraabdominal pressure, which may negatively affect the perfusion of organs by impeding venous return. The aim of our study is to monitor the effect of laparoscopic surgery on cerebral oxygenation in pediatric patients,by using NIRS monitoring; to detect adverse conditions that may develop; and to evaluate the measures that can be taken. Materials and Methods : Celal Bayar University Hafsa Sultan Hospital Ethics Committee approval was obtained for the study. Using the same general anesthesia protocol; twenty-five pediatric patients case who underwent laparoscopic surgery and twenty-six pediatric patients who had laparoscopy indication but underwent open surgery were included in the study as the control group. Demographic data of the patients; previous surgery, additional disease and drug use were recorded by obtaining detailed information from their parents and their patients files. Hemodynamic data of all patients, cerebral oxygenation values measured via NIRS method, were recorded at regular intervals from first entrance to the operating room up until the end ofsurgery. Results : In our study, more than 20 % desaturation from baseline was observed in NIRS measurements in two of twenty-five pediatric patients who underwent laparoscopic surgery, while a decrease of more than 20 % was not detected in twenty-six patients who underwent open surgery. Under 56 appropriate conditions, it was concluded that, there is no significant difference in terms of cerebral oxygenation between laparoscopic and open surgery. In parallel with previous studies, we see that if patients do not have substantial comorbidity or additional operation position issues to consider, and when appropriate İAP values are met, the laparoscopic surgery is safe. Conclusion : Physiopathological changes that may develop due to pneumoperitoneum applied in laparoscopic surgery may impair cerebral oxygenation and cause cerebral hypoxia. The importance of cerebral oximetry follow up is clearly seen in the pediatric patient group, which requires special attention and care for anesthesiologists, for the safe application of laparoscopic surgery, early diagnosis of hypoxia that may develop and necessary intervention. Key Words : Laparoscopic, Pediatric, NIRS, Serebral Oximetry