Invited Commentary

Excerpt

The two primary tenets of the article by Meininger et al. in this issue [1] will be addressed separately. The first relates to the hemodynamic and respiratory effects of pneumoperitoneum in children. In their article, the authors document that intraabdominal insufflation of CO₂ up to a pressure of 12 mmHg is well tolerated by children who are undergoing laparoscopic fundoplication. They note that the mean arterial pressure, minute ventilation, peak inspiratory pressure, and PCO₂ are all increased during abdominal insufflation. In addition, pH was decreased. However, all of these parameters remained in a physiologic range and were similar to those changes recorded in adults with a pneumoperitoneum of similar pressures. The authors felt that the advantages of minimally invasive surgery—faster recovery and less pain—were well worth the minor changes in these physiologic parameters during the operative procedure. …