Background
Laparoscopic appendectomy is the accepted surgical approach for appendicitis in centers worldwide. Laparoscopic surgery requires the creation of a pneumoperitoneum to facilitate surgical access. Laparoscopic surgery affects the respiratory mechanics of patients under general anesthesia. In pediatric patients, there is very little published data that has investigated this effect.
Aims
This feasibility study aims to determine whether it is possible to continually track the respiratory mechanics of patients undergoing laparoscopic appendectomy utilizing respiratory oscillometry.
Methods
Single center, prospective, observational feasibility study conducted at a Tertiary Pediatric center in Western Australia, between May 2020 and April 2023. Patients with known difficult airways, thoracic malformations, and severe cardiopulmonary disease were excluded. Respiratory oscillometry was utilized to measure Reactance (Xrs) and Resistance (Rrs) in all patients to determine the effects of pneumoperitoneum on the respiratory mechanics at specific time points through the surgical procedure.
Results
One hundred & Fifty-Four (154) pediatric patients, male & female, between the ages of 2–16 years, undergoing laparoscopic appendectomy were approached. One hundred were recruited to the study with 99 included in the final analysis. Feasibility was demonstrated in terms of both patient acceptance (65% recruitment rate) and the collection of acceptable, usable and reproducible data from 80% of recruited patients.
Conclusion
The utilization of respiratory oscillometry has previously been described in pediatric literature, but this has been limited to studies of isolated points in time. This study has demonstrated that it is both feasible and acceptable to continuously measure respiratory mechanics in pediatric patients and that future larger randomized control trials are warranted based on these findings.
Trial Registration
ANZCTR 12620000380998
Highlights
- Respiratory oscillometry has been used in isolated points of patient care to determine respiratory mechanics and adjust ventilation settings as required.
- Pneumoperitoneum, required for laparoscopic surgery, affects the respiratory mechanics of pediatric patients, but there is limited data published on these effects.
- This study has investigated the feasibility of utilizing continual respiratory oscillometry in theater to determine respiratory mechanics in children undergoing laparoscopic surgery.
- The utility of continuous respiratory oscillometry may allow for the provision of safer anesthesia by allowing for a more individualized approach to ventilation in pediatric patients in theater.