Laparoscopic Fundoplication: Anesthesia, Analgesia, and Physiologic Aspects

ABSTRACT The anesthetic and physiologic aspects of the authors' first 51 laparoscopic Nissen fundoplications are reviewed (age range 5 months to 20 years; weight 4.4–69 kg). Fourteen patients (27%) had associated severe respiratory disease, and 15 patients (29%) had feeding difficulties requiring additional gastrostomy formation. The median duration of anesthesia was 120 min (60–300). During the procedure, heart rate and blood pressure increased by 20% over baseline in 18% and 12% of cases, respectively. The median increase in Petco2 was 1.0 kPa (0.3–2.3). After surgery, all patients were cared for on a normal surgical ward except 1 patient with uncorrected congenital heart disease. Postoperative analgesia requirement was oral or rectal analgesics in most patients for 24–48 h. Perioperative complications occurred in 5 cases (10%); none was serious. The median postoperative hospital stay was 2 days (1–9). The authors conclude that laparoscopic fundoplication in children is well tolerated with minimal intra...