Pressure controlled ventilation with 5 vs 10 cm H2O in children undergoing laparoscopic surgery

In recent times laparoscopic surgery has become the treatment modality of choice not only in adults but also in paediatric patients. Creation of carbon dioxide Pneumoperitoneum (Pnp)is an essential component of laparoscopic procedures.Increased intra abdominal pressure due to Pnp causes splinting and cephalad shift of diaphragm , which leads to absolute decrease in functional residual capacity, atelectasis , decreased lung compliance and increased ventilation perfusion mismatch.In paediatric patients due to small airway calibre, increased dead space ventilation there is increase chance of  hypercarbia , acidosis and relative hypoxia.

Pressure Controlled Ventilation uses a decelerating flow , which compensate any potential reduction in ventilation. it enables more homogenous distribution of tidal volume in all ventilated alveoli reducing the amount of atelectasis by an improved alveolar recruitment.The patients receives an appropriate volume independent of circuit compliance and nd changes in fresh gas flow/ leaks around endotracheal tube.

Positive End Expiratory Pressure [PEEP] has been used to attenuate the fall in partial pressure of arterial oxygen that accompanies Pnp. The use of PEEP prevents alveolar atelectasis and cyclical recruitment ,improving lung compliance and correcting  ventilation perfusion mismatch. There is no consensus regarding  the ideal level of PEEP during laparoscopic surgery.

A study suggested that  in adult laparoscopic cholecystectomy, application of 10 cm H2O PEEP during Pnp increases compliance and oxygenation, does not cause hemodynamic and respiratory complicationsand reduces the post operative stress response in comparison to external PEEP OF 5 cm H2O. NO  comparison of various level of PEEP has been evaluated in children.Therefore the  aim of the present study is to compare and asses the effect of 5 and 10 PEEP on oxygenation , ventilation and hemodynamic parameters in children undergoing laparoscopic procedures under general anaesthesia.