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- Title
A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy.
- Authors
Westgarth-Taylor, Chris; de Lijster, Leonnie; van Bogerijen, Guido; Millar, Alastair; Karpelowsky, Jonathan
- Abstract
Background: This study was designed to determine whether a decrease in renal oxygenation occurs during CO pneumoperitoneum in children with normal renal function undergoing laparoscopy. Methods: Near infrared spectroscopy (NIRS) probes were applied to both the lateral flank (T10-L2) and lateral cerebral area of all patients with normal renal function undergoing a laparoscopic procedure. Information was recorded in 5-s intervals for 15-min before, during, and for 15-min after pneumoperitoneum insufflation and desufflation. Simultaneously, additional hemodynamic parameters (arterial saturation, mean arterial pressure, end tidal CO, and urine output) were recorded every 5-min. Pneumoperitoneum pressures used were: 0-1 month old, <6 mmHg; 2-12 months old, <8 mmHg; 1-2 years old, <10 mmHg, and 2-8 years old, <12 mmHg. The lowest possible pressure was used to obtain adequate vision. Results: Twenty-nine patients were enrolled in the study. Renal regional oxygen saturation (rSO) did not decrease significantly between baseline (preinsufflation), insufflation, and desufflation of the pneumoperitoneum ( p = 0.343). Meta-analysis of this data demonstrated a pooled weighted difference of −1.4 (−3.5 to 0.54), confirming no significant change. A significant increase in cerebral rSO occurred during the insufflation period of the CO pneumoperitoneum ( p = 0.001). Heart rate ( F = 11.05; p < 0.001) and mean arterial pressure (MAP) ( F = 19.2; p < 0.001) also increased significantly during the laparoscopy. No significant correlation was identified between fluid input and urine output during the laparoscopy ( r = 0.012; p = 0.953). Conclusions: Renal hypoxia does not occur during laparoscopic surgery in children if the minimum age-appropriate intra-abdominal pressures are used. Alternative causes must account for the oliguria and anuria demonstrated in children undergoing laparoscopy.
- Subjects
OXYGENATION (Chemistry); PNEUMOPERITONEUM; LAPAROSCOPIC surgery; NEAR infrared spectroscopy; INSUFFLATION; PEDIATRIC surgery nursing; THERAPEUTICS
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2013, Vol 27, Issue 10, p3696
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-013-2950-3