Use of impedance cardiography to monitor haemodynamic changes during laparoscopy in children

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.