Kamata Mineto
Masui. 2016 Sep;65(9):924-929.
The advantages of laparoscopic surgery resulting in quicker recovery from surgery, decreased postopera- tive pain, shorter hospital stay, and an: improved cos- metic outcome compared to open surgery have led to the expansion of its applications. This expansion includes its use for new surgical procedures as well as indications in younger patients even neonates. The majority of surgical procedures in children are at- tempted under laparoscopy, ranging from short pro- cedures such as day surgeries to even longer case such as congenital biliary atresia. The anesthetic man- agement of laparoscopic surgery in pediatric population has unique features and pitfalls. This chapter de- scribes : (i) the application of laparoscopic surgery for pediatrics ; (ii) the physiological effects of pneumo- peritoneum on respiratory, cardiovascular, renal sys- tems and intracranial pressure ; and (iii) actual anes- thesia management To accomplish safe anesthetic management of the pediatric patients for laparoscopic surgery, anesthesiologists should be familiar with the basic tenets of pediatric anesthesia as well as the potential physiological changes that result from in- creased intra-abdominal pressure due to insufflated CO2, the absorbed CO2, and patient positioning.
与开放手术相比，腹腔镜手术具有术后恢复更快、术后疼痛减轻、住院时间缩短以及美容效果更佳等优势，这促使其应用范围不断扩大。这种扩大包括将其用于新的外科手术以及应用于更年轻的患者甚至新生儿。大多数儿童外科手术都尝试在腹腔镜下进行，范围从诸如日间手术等简短手术到诸如先天性胆道闭锁等更长时间的手术。小儿腹腔镜手术的麻醉管理具有独特的特点和陷阱。本章描述：（i）腹腔镜手术在儿科的应用；（ii）气腹对呼吸、心血管、肾脏系统和颅内压的生理影响；以及（iii）实际的麻醉管理。为了实现对小儿腹腔镜手术患者的安全麻醉管理，麻醉医生应熟悉小儿麻醉的基本原则以及因注入二氧化碳导致腹腔内压力增加、二氧化碳吸收和患者体位所引起的潜在生理变化。
