Upward displacement of the diaphragm leads to preferential ventilation of non-dependant parts of the lungs. This results in ventilation perfusion mismatch. This is accentuated during positive pressure ventilation and by the trendelenburg position

High IAP permits insufflated gas to gain access to tissue spaces, which explains occasional reports of pneumothorax and pneumomediastinum. A postoperative chest X-ray should be obtained.

Neurologic Effects Hypercapnia leads to increase in the systemic venous return, which combined with head down positioning lead to elevation in the ICP.

Endocrinologic Effects: Increase in the blood levels of 'stress hormones' i.e. insulin, cortisol, prolactin, epinephrine, blood levels of lactate, glucose and interleukin-6.

Perioperative Management: The child presenting for laproscopic surgery should be managed in exactly the same way as any child presenting for surgery.

Premedication: Oralmidazolam 0.5- 0.75mg/kg 15-30mins preoperatively. The use of atropine is associated with lower incidence of cardiovascular and airway complications. One advantage of anticholinergic premedication is to prevent vasovagal reflexes that are occasionally seen when the peritoneum is penetrated.