Introduction:

Laparoscopy permits inspection of the abdominal and pelvic organs and the intraperitoneal space with cameras without disturbing the anatomic relationships of these structures. The laparoscopic approach to pediatric surgery reduces hospital costs, allows earlier hospital discharge and a more rapid return to a normal diet and full activity.

The premature and term neonates present the greatest differences in anatomy and physiology from adults. Children also have different psychological needs. The following is a very brief account on the essential aspects of Pediatric anesthesia

Physiological Changes:

Although the peri-operative management of children undergoing laparoscopy is essentially identical to that that for other intra-abdominal procedures, two factors conspire to make anesthesia challenging namely
Creation Of Pneumoperitoneum: The creation of pneumoperitoneum with insufflated gas permits visualization and manipulation of the abdominal viscera. The volume of insufflating gas necessary for pneumoperitoneum is much lower in children than adults. Adults require 2.5L to 5L where as a 10 kg patient needs about 0.9L. Safety precautions must be taken if one is using the verres insufflator needle - namely aspiration, injection and the hanging drop technique so that the serious consequences of gas embolism can be avoided. The risk of injuries to vascular and visceral structures from the verres needle is higher in infants. The ideal gas for insufflation would have
Carbon dioxide (CO2) approaches the ideal insufflating gas. As Laparoscopy frequently involves the use of bipolar diathermy or lasers, this insufflated gas must not support combustion.

Disadvantages of CO2 for insufflation:
Intra-Abdominal Pressure (IAP): The creation of pneumoperitoneum raises the IAP, which has significant cardiovascular, respiratory and neurologic effects.