By Langer J.C., Albanese C.T.
This authoritative consultant studies the evoloving evidence-based literature for a large choice of methods and strategies in pediatric minimal-access surgical procedure. It presents expertly written chapters that disguise the innovations particular to a wide variety of ailments, in addition to present advances in urology, neurosurgery, and spinal and cardiac surgical procedure. The booklet specializes in key theories and purposes instead of technical info, emphasizes the foundations of perform and the newest facts to aid its use, and covers person ailments and techniques inside pediatric basic surgical procedure. The editors emphasize evidence-based methods and supply a world standpoint at the subject.
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Extra info for Pediatric Minimal Access Surgery
Using the lowest possible insufflation pressures, judicious hydration and careful monitoring of blood pressure have made MAS possible for these patients. Fluid administration is particularly critical because the passive pulmonary circulation relies on systemic blood pressure to maintain oxygen saturation. Sluggish flow through synthetic systemicto-pulmonary shunts may precipitate thrombosis and death. Because of the lack of reliability of end-tidal CO2 monitoring and delicate fluid balance, invasive arterial catheters may be necessary in all but the most basic procedures for this patient population in order to avoid severe acidosis from inadequate ventilation or poor peripheral perfusion.
Joris et al. (22) studied 15 non-obese healthy adults undergoing laparoscopic choplecystectomy under general anesthesia using invasive hemodynamic monitoring via flow-directed pulmonary artery catheters. The study showed that insufflation pressures of 15 mmHg caused an increase in mean arterial pressure (MAP) of 35%, decrease in CI of 20%, increase in SVR of 65%, and an increase in pulmonary vascular resistance (PVR) of 90%. When combined with general anesthesia and the reverse Trendelenberg position of 108, CI decreased 50%.
Fujimoto T, Lane GJ, Esaki S et al. Laparoscopic extramucosal pyloromyotomy versus open pyloromyotomy for infantile hypertrophic pyloric stenosis: which is better? J Pediatr Surg 1999; 34:370 – 372. Curran TJ, Foley MI, Swanstrom LL et al. Laparoscopy improves outcome for pediatric splenectomy. J Pediatr Surg 1998; 33:1498– 1500. Rothenberg SS. Experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg 2003; 38:102 –104. Rothenberg SS. Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children.