Methods: Haemodynamic changes were measured noninvasively using impedance c
ardiography (ICG) in 30 ASA I children during laparoscopic varicocelectomy
under general anaesthesia. After induction and intubation, mechanical venti
lation was started, then pneumoperitoneum (PP) was created. During the cour
se of anaesthesia, values of endtidal CO2 pressue (PECO2), peak inspiratory
airway pressure (PIP), heart rate (HR), mean arterial blood pressure (MABP
), stroke volume index (SVI), cardiac index (CI) and systemic vascular resi
stance index (SVRI) were recorded at 1 min intervals. We analysed four peri
ods: T1, before induction; T2, after induction; T3, during PP; T4, after de
sufflation of PP until awake.
Results: After induction of anaesthesia a significant reduction of HR, MABP
and CI was recorded. Creating PP together with the use of a 15 degrees hea
d down tilt resulted in a further drop in CI, mainly caused by the reductio
n of SVI, and an elevation of MABP and SVRI. We measured a 25% total decrea
se of CI.
Conclusions: Our patients tolerated this significant reduction of cardiac o
utput well. We have demonstrated that ICG can be used to track the haemodyn
amic changes caused by PP in children, and suggest that this type of monito
ring is useful in this group of age during laparoscopy.