1998 Volume 18 Issue 6 Pages 592-596
We report the anesthetic course of laparoscopic ovarian cystectomy in a newborn infant. A 19-day-old infant (height, 52cm; weight, 3, 900g) was presented with appetite loss and a right ovarian cyst diagnosed with ultrasonography antenatally. The patient was born at 41 week's gestation, weighed 3, 860g at birth, and had no concurrent abnormalities. Anesthesia was maintained with sevoflurane, nitrous oxide, fentanyl and pancuronium. The patient tolerated intraabdominal pressure (IAP) of 8mm Hg well in the horizontal position. When IAP of 7mm Hg was combined with a head-down tilt of 10°, higher peak inspiratory pressure was required to maintain PaCO2 within a normal range, the arterial to end-tidal carbon dioxide gradient (a-ETDCO2) increased to 12mm Hg, and inferior vena cava pressure (IVCP) increased to 16mm Hg. The surgery was completed without complications, the patient recovered uneventfully. Presumably, the changes in a-ETDCO2 and IVCP were due to an increase in pleural pressure by the cephalad movement of the diaphragm. It is suggested that PaCO2 could be underestimated during pneumoperitoneum combined with the Trendelenburg position in newborn infants. IVCP could be a guide for safe pneumoper-itoneum and positioning in neonates, as is in repair of abdominal wall defects.
