Pneumoperitoneum and hemodynamic stability during pediatric laparoscopic appendectomy

Background: Conventional pneumoperitoneum (CP) and automatically maintained pneumoperitoneum using AirSeal Intelligent Flow System (AiFS) were compared during pediatric laparoscopic appendectomy (LA) using intraperitoneal pressure (IPP) and hemodynamic parameters. Methods: A prospective review of 39 children aged 3-14 years who had standard 3-trocar LA was performed. Pneumoperitoneum was either AiFS (n = 18) or CP (n = 21) according to the surgeon's preference. IPP during insertion of trocars in all subjectswas initially 8-10 mmHg, which was reduced to 5 mmHg then maintained until LA was completed. Data were collected every 5 min during pneumoperitoneum. Results: Subject demographics were similar for both groups. During pneumoperitoneum, average IPP (AiFS: 7.9; CP: 9.0 mmHg), average systolic blood pressure (AiFS: 100.4; CP: 106.9 mmHg), and average end-tidal CO2 (EtCO2; AiFS: 35.7; CP: 38.5 mmHg) were significantly different (p < .05, respectively), while pulse (AiFS: 92.1; CP: 96.4 bpm), oxygen saturation (AiFS: 98.8; CP: 98.8%), body temperature (AiFS: 37.2; CP: 37.4), urine output (AiFS: 2.7; CP: 2.4 mL/kg per hour), operative time (AiFS: 72.2; CP: 76.2 mins), blood loss (AiFS: 3.6; CP: 3.5 mL), recommencement of oral intake (AiFS: 1.3; CP: 1.4 days), and postoperative hospitalization (AiFS: 4.3; CP: 3.8 days) were not. Conclusion: Because IPP was significantly lower during LA with AiFS, EtCO2 and BP were significantly lower. Level of evidence: Treatment study; prospective comparative study - level II. (C) 2016 Elsevier Inc. All rights reserved.