LUNG COMPLIANCE DURING LAPAROSCOPIC SURGERY IN PEDIATRIC-PATIENTS

Insufflation of CO2 and positioning of patients induces changes in car diovascular and respiratory function during laparoscopic procedures. T his study was initiated to assess respiratory mechanics such as lung c ompliance and peak airway pressure (PIP) during laparoscopic surgery i n paediatric patients. Ten consecutive patients (age 1-15 years) sched uled for laparoscopic procedure were included in this open prospective single-group study. Anaesthesia was induced and maintained with intra venous infusions of propofol and alfentanil. Vecuronium was administer ed to maintain muscle relaxation. Head down tilt induced a mean decrea se of 17% in lung compliance, which was further decreased by 27% from the baseline during insufflation of intraabdominal CO2 (intraabdominal pressure 12 mmHg). Coincidently, PIP increased by 19% and 32% from th e baseline during Trendelenburg position and peritoneal insufflation. Lung compliance and PIP returned to their respective baseline values a fter removal of CO2 from the peritoneal cavity. Endtidal CO2 increased from a baseline value of 4.3 kPa to 5.4 kPa (33-42 mmHg) during surge ry when ventilator settings were not altered. We conclude that insuffl ation of CO2 induces significant increases in peak airway pressure wit h simultaneous decreases in lung compliance.