Laparoscopy is the preferred surgical approach in certain abdominal procedures as it provides several advantages compared to open surgery, including minimal surgical incision, shorter hospital stays, less pain after the operation, and earlier mobilisation. However, gas insufflation into the abdomen increases abdominal pressure with consequent changes in respiratory mechanics and derecruitment of lung volume. Patients undergoing laparoscopic surgery are normally anaesthetised, muscle relaxed, intubated and mechanically ventilated. Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications. One of the guiding principles of lung-protective ventilation is to recruit the lung and to use the lowest level of positive-end expiratory pressure (PEEP) that keeps the lung open. However, adequate tools are lacking in the operating theatre for monitoring lung volume recruitment and guiding the anaesthetist in the selection and adjustment of the optimal PEEP level for each individual patient. The forced oscillation technique (FOT) is a non-invasive method for the assessment of lung mechanics, which has been successfully applied in ventilated patients.
This study will evaluate whether this novel approach of continuous monitoring of respiratory mechanics is feasible in children undergoing laparoscopic appendectomy. The results will help paediatric anaesthetists to formulate new evidence-based ventilation guidelines and policies to optimise and personalize the ventilation strategy in children undergoing laparoscopic surgery. This novel, custom-made device for the anaesthesia setting has the potential to be highly valuable in clinical practice in the future, particularly when caring for children with complex co-morbidities and/or surgery affecting the cardio-respiratory system, for example, neonates with diaphragmatic hernias or gastroschisis.
Professor Britta Regli-von Ungern Sternberg
Dr Michael Collin
Dr Mon Ohn
Perth Children’s Hospital, Western Australia.
The project was awarded $A70,000 funding through the ANZCA research grants program for 2023.