Anaesthetic considerations for minimal access surgery (MAS) in children

Abstract

Though often called minimally invasive, the "Minimal Access Surgery (MAS)" appears a correct term for laparoscopically performed operations, more so in children. The term non invasive is false and minimally invasive is misleading, as many operations can be quite invasive. It is not synonymous with minor surgery and never a minor anaesthesia. The MAS is truly a great surgical advance in adults and is also becoming a useful tool in children, for many intra abdominal, thoracic (throracoscopy) and intracranial diagnostic and therapeutic procedures. The major benefits are thought to result from avoidance of a large incision and excessive tissue handling. Though fairly safe in experienced hands, serious surgical and anaesthetic complications are possible. These are essentially related to the experience of the treating staff and limited space available for manipulation in children. The anesthetist should ensure an empty stomach and urinary bladder and optimal hydration before induction of a balanced endotracheal anaesthesia, with adequate muscle relaxation, monitoring and post-operative follow up. He / she should be prepared if the procedure becomes lengthy with possible risks of bleeding and venous gas embolism. Finally a patient who is not fit for a conventional operation is also not fit for MAS.