Vol. 73 - No. 3 MINERVA ANESTESIOLOGICA 161 MINERVA MEDICA COPYRIGHT ® MINERVA ANESTESIOL 2007;73:161-71 PEDIATRIC ORIGINAL ARTICLE Thoracoscopy in children: anaesthesiological implications and case reports A. GENTILI 1 , M. LIMA 2 , R. DE ROSE 1 , A. PIGNA 1 , V. CODELUPPI 1 , S. BARONCINI 1 1 Department of Anestesia, and Intensive Care Antalgic Therapy, University Hospital of Bologna, Policlinico S. Orsola- Malpighi, Bologna, Italy; 2 Department of Obstetrics, Gynecology and Pediatrics, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy ABSTRACT Aim. Videoassisted thoracic surgical technique in children is being used with increasing frequency for an extensive vari- ety of diagnostic and therapeutic procedures. The aim of the study was to assess respiratory, cardiocirculatory and body temperature changes in children undergoing thoracoscopy and to identify if the trend of such changes was mod- ifiable by factors such as lung exclusion, length of the thoracoscopy and preoperative respiratory compromise. Methods. A total of 50 patients (38 boys and 12 girls) undergoing general anaesthesia for diagnostic and therapeutic thoracoscopic procedures were analysed. The values of the monitored parameters were compared at 6 specific times: T1 - at the end of anaesthesia induction (considered the basal level); T2 - after lateral position; T3 - before pleural CO 2 insufflation; T4 - 10 min after pleural CO 2 insufflation; T5 - before pleural deflation; T6 - 10 min after pleural defla- tion. Results. All patients tolerated the thoracoscopy well, without intraoperative complications. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower, and end-tidal CO2 (PETCO 2 ) significantly higher dur- ing thoracoscopy. Body temperature (BT) had a statistically significant reduction during thoracoscopy and after pleu- ral deflation. During one-lung ventilation the PETCO 2 increased compared to two-lung ventilation with intrapleur- al insufflation, while during two-lung ventilation with intrapleural insufflation SBP and DBP decreased compared to one-lung ventilation. The length of the thoracoscopy increased the PETCO 2 and reduced the BT. The preopera- tive respiratory compromise increased the PETCO 2 . Conclusion. Although thoracoscopy in children brings about certain respiratory, cardiocirculatory and body temper- ature changes, it is nevertheless a safe and efficient surgical technique. Key words: Thoracoscopy - Pediatrics - Anaesthesia - Respiratory physiologic processes - Cardiocircolatory system - Body temperature - Ventilation, mechanical, methods - Insufflation. T he videoassisted thoracic surgical technique in children is being used with increasing fre- quency for a variety of diagnostic and therapeutic procedures. Thoracoscopy in the paediatric patient reduces surgical trauma and minimizes postoper- ative morbidity. The advantages of thoracoscopy compared with open thoracotomy include decreased postoperative pain, shorter hospital stay, more rapid return to normal activities, better cos- metic results and decreased incidence of chest wall deformity. 1-3 An optimal approach to the planning of anaes- thesia for thoracoscopy requires a good knowl- edge of the technical requirements and an under- standing of the physiological alterations associat- ed with the procedure. The approach needs to take into account the problems and risks related to air- way management, potential preoperative respira- tory compromise and respiratory consequences associated with a possible lung resection, as well as those connected with the changes due to the lat- eral decubitus position, the lung exclusion and the CO 2 insufflation in the pleural cavity. 3 From a respiratory point of view the sequence MINERVA MEDICA COPYRIGHT ®