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Articles 241 - 270 of 308
Full-Text Articles in Anesthesia and Analgesia
Anaesthetic Management Of Neonatal Primary Hyperparathyroidism, Anwar-Ul-Huda, Sanam Dost Mohammad, Tauseef Ahmed
Anaesthetic Management Of Neonatal Primary Hyperparathyroidism, Anwar-Ul-Huda, Sanam Dost Mohammad, Tauseef Ahmed
Department of Anaesthesia
Neonatal primary hyperparathyroidism (NPHP) is a rare disease that presents in the first 6 months of life. It is almost invariably fatal unless a prompt diagnosis is made and urgent surgical intervention is instituted. Patients with hyperparathyroidism require special preoperative considerations. They require proper work-up from cardiac, renal and neurological point of view, correction of intravenous volume and electrolytes irregularities. We are presenting a case of an infant who started to have cyanosis and lethargy at 21st day of life. Initial diagnosis of pneumonia was made but later on diagnosed as hyperparathyroidism. He was planned for parathyroidectomy under general anaesthesia. …
Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad
Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad
Department of Anaesthesia
Objective: To determine the accuracy of the Upper lip bite test and Mallampati test in predicting difficult endotracheal intubation.Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, a tertiary care facility in Karachi, Pakistan. Between June 1,2007 and May 31, 2008, 324 adult patients undergoing elective surgeries requiring general anaesthesia with endotracheal intubations were enrolled. Pre-operatively upper lip bite test and Mallampati test were performed for the assessment of airway by a specifically trained observer. Laryngoscopic view was rated by using Cormack and Lehane laryngoscopic grading once the patient was fully anaesthetised using standard anaesthesia technique. Completed …
The Crucial Role Of Bilateral Infraclavicular Nerve Blocks In The Anesthetic Management Of A Trauma Patient, Eric P. Chiang, Paul Dangerfield, Jaideep H. Mehta, Marian Sherman, Jeffrey S. Berger
The Crucial Role Of Bilateral Infraclavicular Nerve Blocks In The Anesthetic Management Of A Trauma Patient, Eric P. Chiang, Paul Dangerfield, Jaideep H. Mehta, Marian Sherman, Jeffrey S. Berger
Anesthesiology and Critical Care Medicine Faculty Publications
Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.
Spinal Anaesthesia For Caesarean Section: Plain Vs Hyperbaric Bupivacaine, Gurmukh Das Punshi, Gauhar Afshan
Spinal Anaesthesia For Caesarean Section: Plain Vs Hyperbaric Bupivacaine, Gurmukh Das Punshi, Gauhar Afshan
Department of Anaesthesia
Objective: To compare the clinical characteristics of sensory and motor block as well as haemodynamic stability using plain and hyperbaric bupivacaine in spinal anaesthesia for caesarean section.Methods: Two equal groups were formed from a total of 60 patients who were enrolled in this prospective randomised double-blinded study that was done at tertiary care hospital in Karach, during 2005 to 2006. Equal volume of plain and hyperbaric bupivacaine 10 mg with 25 mcg of fentanyl was used for spinal anaesthesia in the two groups that were formed on the basis of random allocation. Characteristics of sensory and motor block, episodes of …
Trpv1 Antagonists May Exacerbate Sepsis In Aged Mice: Should We Be Nervous?, Zenaide M.N. Quezado, Arpad Szallasi
Trpv1 Antagonists May Exacerbate Sepsis In Aged Mice: Should We Be Nervous?, Zenaide M.N. Quezado, Arpad Szallasi
Anesthesiology and Critical Care Medicine Faculty Publications
No abstract provided.
Spontaneous Intracranial Hypotension In A Patient With Marfan's Syndrome Treated With Epidural Blood Patch--A Case Report, Samad Khalid, Punshi Gurmukh Das, Hamid Mohammad, Ullah Hameed
Spontaneous Intracranial Hypotension In A Patient With Marfan's Syndrome Treated With Epidural Blood Patch--A Case Report, Samad Khalid, Punshi Gurmukh Das, Hamid Mohammad, Ullah Hameed
Department of Anaesthesia
Spontaneous intracranial hypotension (SIH) is a well-defined clinical entity that is frequently misdiagnosed. We are reporting a case of 38 years old male who presented with severe headache and an episode of generalized tonic-clonic seizure. He was managed successfully with an epidural blood patch. Understanding of the characteristics, symptomatology, evaluation, treatment options, and prognosis is discussed.
Neurodevelopmental Consequences Of Sub-Clinical Carbon Monoxide Exposure In Newborn Mice, Ying Cheng, Adia Thomas, Feras Mardini, Shannon L. Bianchi, Junxia X. Tang, Jun Peng, Huafeng Wei, Maryellen F. Eckenhoff, Roderic G. Eckenhoff, Richard J. Levy
Neurodevelopmental Consequences Of Sub-Clinical Carbon Monoxide Exposure In Newborn Mice, Ying Cheng, Adia Thomas, Feras Mardini, Shannon L. Bianchi, Junxia X. Tang, Jun Peng, Huafeng Wei, Maryellen F. Eckenhoff, Roderic G. Eckenhoff, Richard J. Levy
Anesthesiology and Critical Care Medicine Faculty Publications
Carbon monoxide (CO) exposure at high concentrations results in overt neurotoxicity. Exposure to low CO concentrations occurs commonly yet is usually sub-clinical. Infants are uniquely vulnerable to a variety of toxins, however, the effects of postnatal sub-clinical CO exposure on the developing brain are unknown. Apoptosis occurs normally within the brain during development and is critical for synaptogenesis. Here we demonstrate that brief, postnatal sub-clinical CO exposure inhibits developmental neuroapoptosis resulting in impaired learning, memory, and social behavior. Three hour exposure to 5 ppm or 100 ppm CO impaired cytochrome c release, caspase-3 activation, and apoptosis in neocortex and hippocampus …
Sedation Safety Using Clinical Practice Guidelines, Bonnie Wasilowsky Bspa-Hca, Rn, Cnrn
Sedation Safety Using Clinical Practice Guidelines, Bonnie Wasilowsky Bspa-Hca, Rn, Cnrn
Patient Care Services / Nursing
No abstract provided.
Examining Cancer-Related Pain And Quality Of Life In Lehigh Valley Home Care Patients, Linda G. Alley Phd, Rn, Hannah D. Paxton Rn, Mph, Michelle D. Flores Bsn, Rn, Carol A. Foltz Phd, Jen Wike Mph, Mba, Vickie Cunningham Bsn, Rn, Jeffrey Etchason Md
Examining Cancer-Related Pain And Quality Of Life In Lehigh Valley Home Care Patients, Linda G. Alley Phd, Rn, Hannah D. Paxton Rn, Mph, Michelle D. Flores Bsn, Rn, Carol A. Foltz Phd, Jen Wike Mph, Mba, Vickie Cunningham Bsn, Rn, Jeffrey Etchason Md
Administration & Leadership
No abstract provided.
Are We Anesthesiologists, Aware About The Incidence Of Muscle Stiffness Associated With Remifentanil?, Gauhar Afshan
Are We Anesthesiologists, Aware About The Incidence Of Muscle Stiffness Associated With Remifentanil?, Gauhar Afshan
Department of Anaesthesia
No abstract provided.
Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah
Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah
Department of Anaesthesia
BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …
Laryngeal Mask Airway Insertion Anaesthesia And Insertion Techniques, Abdul Monem, Fauzia A. Khan
Laryngeal Mask Airway Insertion Anaesthesia And Insertion Techniques, Abdul Monem, Fauzia A. Khan
Department of Anaesthesia
Laryngeal Mask Airway has gained wide acceptance for routine airway management, difficult airway and in emergency situations. The classical method of insertion was recommended by Dr Brain. Over the years various induction and insertion techniques have been described with variable results. Combination of induction agents with narcotics, with or without small dose muscle relaxants has been found to be very effective. There is less also lesser incidence of mucosal trauma with partially inflated cuff. Insertion with cuff facing laterally or backwards and rotating it forwards into position has also been described. A review of various options and their advantages and …
Audit Of An Acute Pain Service In A Tertiary Care Hospital In A Developing Country, Muhammad Qamarul Hoda, Mohammad Hamid, Fauzia Anis Khan
Audit Of An Acute Pain Service In A Tertiary Care Hospital In A Developing Country, Muhammad Qamarul Hoda, Mohammad Hamid, Fauzia Anis Khan
Department of Anaesthesia
The first anaesthesia based acute pain service (APS) was introduced in Pakistan at the Aga Khan University Hospital in July 2001, with the aim of patient safety and satisfaction. The American Society of Anesthesiologist task force guidelines were used for the introduction of APS. APS has managed 6810 patients during four and half years period. Common analgesic techniques used, were intravenous infusion (50%), patient controlled intravenous analgesia (18%) and epidural infusions (30%). Common reported side effects were nausea and vomiting with intravenous infusion (10%) and PCIA (10%) while motor block was noticed with epidural infusion (29%). This article aims to …
Comparison Of Two Sedation Techniques In Patients Undergoing Surgical Procedures Under Regional Anaesthesia, Aliya Ahmed, Fauzia Anis Khan, Aziza Hussain
Comparison Of Two Sedation Techniques In Patients Undergoing Surgical Procedures Under Regional Anaesthesia, Aliya Ahmed, Fauzia Anis Khan, Aziza Hussain
Department of Anaesthesia
Objective: Intraoperative comfort and patient satisfaction during surgical procedures under regional anaesthesia can be improved with the use of supplemental intravenous sedation. The authors conducted a study to compare two sedation techniques for surgical procedures performed under regional anaesthesia, i.e., midazolam and pethidine combination compared with midazolam and tramadol combination.Methods: Forty adult American Society of Anaesthesiologists (ASA) grade 1-111 patients, aged between 40-65 years undergoing surgery under regional anaesthesia (sub-arachnoid block) were included. The patients were randomly divided into two groups. All patients received standardized premedication, intraoperative monitoring and oxygen therapy. Group A patients received midazolam 0.03 mg/kg followed by …
Epidural Anaesthesia During Labour For A Patient With Congenital Complete Heart Block: A Case Report, Abdul Monem, Ursula Chohan, Mohammed Ali
Epidural Anaesthesia During Labour For A Patient With Congenital Complete Heart Block: A Case Report, Abdul Monem, Ursula Chohan, Mohammed Ali
Department of Anaesthesia
We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only …
Role Of Stellate Ganglion Block In Post Cabg Sympathetically Mediated Chest Pain, Mueen Ullah Khan, Imtiaz Ahmed
Role Of Stellate Ganglion Block In Post Cabg Sympathetically Mediated Chest Pain, Mueen Ullah Khan, Imtiaz Ahmed
Department of Anaesthesia
Acute chest pain is a common presentation in emergency. After clinical assessment undiagnosed chest pain can become a difficult problem. Sympathetically mediated chest pain is a rare presentation, as it is similar to that of secondary hyperalgesia in the intact skin surrounding an injury site. We are reporting a case of a 62 years old man who presented with atypical chest pain four months after coronary artery bypass grafting (CABG). On investigation no new change was noticed than previous evaluation. On chronic pain assessment he was having hyperalgesia to light touch in addition to the spontaneous chest pain. He was …
Arterial To End-Tidal Carbon Dioxide Difference In Neurosurgical Patients Undergoing Craniotomy: A Review Of Practice, Fauzia Anis Khan, Mueenullah Khan, Shemila Abbasi
Arterial To End-Tidal Carbon Dioxide Difference In Neurosurgical Patients Undergoing Craniotomy: A Review Of Practice, Fauzia Anis Khan, Mueenullah Khan, Shemila Abbasi
Department of Anaesthesia
Objective: To see if PETCO2 reflects PaCO2 with acceptable accuracy.Methods: In this audit the.anaesthetic chart of fifty consecutive patients, age 12 years and above undergoing craniotomy for intracranial pathology, were reviewed.Results: The difference between end tidal carbon dioxide (ETCO2) value corresponding to the time of taking the arterial sample and the PaCO2 was calculated. The mean end tidal CO2 was 29.3 +/- 2.8 and the mean PaCO2 was 32.63 +/- 4.5. The mean difference between the two values was calculated as 4.09 +/- 3.0. The regression coefficient was 0.496, which showed a moderate association. A wide variability was observed in …
Severe Anaphylactic Reaction At Induction Of Anaesthesia, Aliya Ahmed, Anand Kumar
Severe Anaphylactic Reaction At Induction Of Anaesthesia, Aliya Ahmed, Anand Kumar
Department of Anaesthesia
Anaphylaxis is an IgE mediated severe allergic reaction causing release of vasoactive substances from mast cells and basophils after re-exposure to an antigen. Signs and symptoms include flushing, urticaria, hypotension, tachycardia, bronchospasm, cardio-respiratory arrest etc. It can occur at induction of anaesthesia when multiple drugs are being administered, but prompt diagnosis with correct management is the key to a successful outcome. This case report describes a patient who developed severe bronchospasm with difficulty in inflating the lungs and dropping oxygen saturations, alongwith hypotension, tachycardia and widespread flushing, at induction of anaesthesia for elective breast surgery. She was promptly managed and …
Intraoperative Analgesia For Day-Care Surgery: Practice Trends, Aliya Ahmed, Shemila Abbasi, Chandar Prakash, Subhash Chandar
Intraoperative Analgesia For Day-Care Surgery: Practice Trends, Aliya Ahmed, Shemila Abbasi, Chandar Prakash, Subhash Chandar
Department of Anaesthesia
Our objective was to determine the trends of providing intraoperative analgesia for day-care surgery among the various anaesthesiologists at our university hospital. All patients having surgical procedures under general anaesthesia in the Surgical Day Care Unit (SDC) of the Hospital were included. The study was done over two months and 142 patients were enrolled during the study period. Of these 45% received pethidine for intraoperative analgesia, 24% pethidine and ketorolac, 6% pethidine and paracetamol suppositories, 18% received fentanyl, 2% tramadol and 5% received other analgesic combinations. Of the 22% patients who received pethidine intraoperatively needed rescue analgesia in recovery room, …
Customer Focused Incident Monitoring In Anaesthesia, F A. Khan, S Khimani
Customer Focused Incident Monitoring In Anaesthesia, F A. Khan, S Khimani
Department of Anaesthesia
The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external …
Perioperative Management Of Pheochromocytoma: Anaesthetic Implications, Aliya Ahmed
Perioperative Management Of Pheochromocytoma: Anaesthetic Implications, Aliya Ahmed
Department of Anaesthesia
Pheochromocytoma is a catecholamine producing tumour that can cause severe hypertension and other systemic disturbances. The perioperative management of pheochromocytoma remains a complicated anaesthesia challenge requiring intensive preoperative preparation and vigilant intraoperative and postoperative care. In this article the perioperative management of pheochromocytoma is reviewed by first summarizing its pathophysiology, clinical aspects and diagnosis, then highlighting the preoperative optimization of the patient and finally describing the intraoperative and postoperative anaesthetic management in the light of the current information.
Anesthetic Deaths In A Developing Country, Mueenullah Khan, Fauzia A. Khan
Anesthetic Deaths In A Developing Country, Mueenullah Khan, Fauzia A. Khan
Department of Anaesthesia
It is important to ascertain the contribution of anesthesia to perioperative mortality in order to enable improvement in the safety and quality of care. Scanty literature regarding anesthetic mortality from developing countries is available. We present data regarding anesthesia related mortality in a university hospital in a developing country. We reviewed all patient deaths occurring between 1992-2003 occurring within 24 hours of anesthesia, as part of departmental quality assurance activity. The aim of study was to identify any contributing factors associated with mortality, and to compare our data with similar studies from developed and developing countries. 111,289 cases were handled …
Tramadol Versus Nalbuphine In Total Intravenous Anaesthesia For Dilatation And Evacuation, Khalid Maudood Siddiqui, Ursula Chohan
Tramadol Versus Nalbuphine In Total Intravenous Anaesthesia For Dilatation And Evacuation, Khalid Maudood Siddiqui, Ursula Chohan
Department of Anaesthesia
Objective: To compare the results of Tramadol with Nalbuphine for dilatation and evacuation with total intravenous anaesthesia technique.Methods: A total of 70 patients (35 in each group) were included in this prospective, double blind randomized study. Intravenous tramadol 1.5 mg/kg and nalbuphine 0.1 mg/kg were compared in total intravenous anaesthesia (TIVA) using a propofol infusion in patients undergoing dilatation and evacuation (D and E). Changes in haemodynamic variables greater than 20% from the base line values were noted.Results: There was no difference found in haemodynamic parameters. There was statistically significant difference found (p < 0.05) in postoperative recovery between the two groups.CONCLUSION: Quality of analgesia was better in nalbuphine group but both drugs provide suitable analgesic supplementation to TIVA.
Anaesthesia For Interventional Neuroradiology, Aliya Ahmed
Anaesthesia For Interventional Neuroradiology, Aliya Ahmed
Department of Anaesthesia
There have been rapid and significant advances in diagnostic and interventional radiology, including interventional neuroradiology, in recent years. Many intracranial vascular pathologies are being successfully managed by endovascular interventional neuroradiology techniques. These techniques include procedures like embolization of vascular tumours and arterio-venous malformations, coiling of cerebral aneurysms. etc. The support of anaesthesia team is requested for these therapeutic endovascular neuroradiological procedures. The main aims of the anaesthesiologist during any interventional neuroradiology procedure are provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. Provision of anaesthesia in remote …
Estimation Of Blood Loss During Caesarean Section: An Audit, Fauzia A. Khan, Mueenullah Khan, Asif Ali, Ursula Chohan
Estimation Of Blood Loss During Caesarean Section: An Audit, Fauzia A. Khan, Mueenullah Khan, Asif Ali, Ursula Chohan
Department of Anaesthesia
Objective: To evaluate the blood ordering practice and blood transfusion for Caesarean sections at our institution and to compare the estimated blood loss between anaesthetists and obstetricians.Methods: A review of 126 patients undergoing both elective and emergency Caesarean section was undertaken in 2002. Information collected included the number of blood units cross-matched preoperatively, type of surgery (emergency or elective), type of anaesthesia, parity of the patient, estimated blood loss by both anaesthetists and obstetricians, intraoperative and postoperative transfusion within 48 hours and pre and post operative haemoglobin (Hb) and haemocrit (Hct).Results: A total of 215 units were cross-matched for 126 …
One Year Experience Of Mri Under General Anaesthesia, Shahla Siddiqui
One Year Experience Of Mri Under General Anaesthesia, Shahla Siddiqui
Department of Anaesthesia
A case series over one year of our experience of using Propofol and Laryngeal mask airway (LMA) in children under 10 years of age undergoing MRI under general anaesthesia is presented. All paediatric patients under the age of ten attending out-patient department were included in the case series starting from January 1st, 2004 till December 31st, 2004. All patients underwent general anaesthesia using Propofol / LMA technique as described in detail in communication below. A total of 78 children were included; the only patient requiring intubation was the youngest: a neonate of 1 day who had a large orbital mass. …
Viral Hemorrhagic Fever - An Icu Perspective, Asghar Ali, Shahla Siddiqui
Viral Hemorrhagic Fever - An Icu Perspective, Asghar Ali, Shahla Siddiqui
Department of Anaesthesia
No abstract provided.
Diagnostic Value Of Chest X-Ray And Echocardiography For Cardiac Tamponade In Post Cardiac Surgery Patients, Mohammad Hamid, Mueen Ullah Khan, Allen C. Bashour
Diagnostic Value Of Chest X-Ray And Echocardiography For Cardiac Tamponade In Post Cardiac Surgery Patients, Mohammad Hamid, Mueen Ullah Khan, Allen C. Bashour
Department of Anaesthesia
Objective: To investigate the effectiveness of X-ray and echocardiography (ECHO) as a diagnostic tool for cardiac tamponade in adult cardiac surgery patients.Methods: Thirty five coronary artery bypass and graft surgery patients who developed cardiac tamponade at Cleveland clinic foundation, were included in this study. Their diagnosis was confirmed at the time of re-exploration in the operating room. These patients were followed retrospectively for demographics, X-ray and echocardiography findings. Abnormal and enlarged cardiac silhouette which was different from first postoperative X-ray was used as radiological criteria for tamponade while echocardiographic diagnosis was left to the discretion of cardiologist.Results: Twenty four males …
Standardization Of Anaesthesia Ready Time And Reasons Of Delay In Induction Of Anaesthesia, Saeed U. Zafar, Fauzia Anees Khan, Mueenullah Khan
Standardization Of Anaesthesia Ready Time And Reasons Of Delay In Induction Of Anaesthesia, Saeed U. Zafar, Fauzia Anees Khan, Mueenullah Khan
Department of Anaesthesia
Objective: Anaesthesia-Ready Time (ART) is the time taken by the anaesthetist to provide sufficient anaesthetic depth for start of surgery. Our aim was to set benchmark timings for ART and compare it with our current practice.Methods: Benchmark ART time of 15 minutes was set for American Society of Anesthesiologists (ASA) class I and II patients, 30 minutes for ASA III and IV patients, 20 minutes for spinal and 30 minutes for epidural anaesthesia. An additional 15 minutes was added for each invasive procedure.Results: Three hundred elective cases were audited. Seventy eight percent of the cases were within benchmark timings. The …
Laparoscopic Surgery In Children--Anaesthetic Considerations, Aliya Ahmed
Laparoscopic Surgery In Children--Anaesthetic Considerations, Aliya Ahmed
Department of Anaesthesia
Laparoscopic surgery has several advantages over conventional surgery for the patient. An increasing number of diagnostic and surgical procedures are being done laparoscopic not only in adults but also in paediatrics patients. In addition to the routine anaesthetic considerations for any surgical patient, the choice of the anaesthetic technique in patients undergoing laparoscopic procedures should consider the patient's underlying cardio respiratory functions induced by the pneumoperitoneum and carbon dioxide [CO2] insufflations. This article describes the physiological alterations induced by laparoscopic procedures in children and the anaesthetic implications of laparoscopic in the paediatric patient population.