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Purpose: This study aimed to measure the effects of the upper or lower limit of the carbon dioxide (CO2) insufflation pressure applied in children who underwent laparoscopic and thoracoscopic interventions, on the changes in the brain and kidney Near Infrared Spectrometry (NIRS) values. Patients and Methods: Demographic information, carbon dioxide insufflation pressure and the operation time data were recorded. During the procedure the NIRS probes monitored the brain and left kidney during laparoscopic procedures and the brain only during thoracoscopic procedures. Basal NIRS values were recorded after anesthesia induction, after CO2 insufflation-beginning of insufflation, near the end of the procedure-end of insufflation, and after carbon dioxide desufflation. During the procedure, when ≥20% decrease was observed in the basal value during carbon dioxide insufflation, the carbon dioxide pressure was decreased and the procedure was continued. In case of a decrease of ≥50% in either brain or kidney NIRS it was planned to be recorded as an absolute decrease, and to terminate laparoscopy or thoracoscopy. Results: Two hundred four laparoscopic and 19 thoracoscopic cases were included in the study. The mean age of the patients undergoing laparoscopic procedures was 120 months, the mean body weight was 33 kg, and the mean operative time was 43 minutes; whereas the mean age of the patients undergoing thoracoscopic procedures was 62 months, the mean body weight was 17 kg, and the mean operative time was 80 minutes. No statistically significant difference was found in NIRS values between upper or lower insufflation pressures (p>0.05). Conclusion: The pressures provided at the upper limit of the safe range may expand the surgical area and can help prevent problems that may be encountered due to the limited space during the surgery. In this study, it has been shown that pressures at the upper limit of the safe range do not impair patient brain and kidney oxygenation.

The aim of this study was to evaluate the incidence of coughing and breath holding in patients undergoing lumbar surgery extubated in prone position, supine position, or supine position with intravenous lidocaine before extubation. About 105 ASA I to II patients undergoing lumbar surgery were extubated in prone position in group P (n35), in supine position in group S (n35) and in supine position with intravenous 1.5 mgkg lidocaine 10 minutes before extubation in group SL (n35). The number of patients who coughed and demonstrated breath holding was noted at emergence period. The time of loss of monitoring while repositioning the patient was recorded. The frequency of cough in group S was higher compared with group P at 1 minute after extubation (P0.008). Two and three minutes after extubation, the patients in group S demonstrated higher cough incidence compared with groups P and SL (P<0.05). The incidence of breath holding in the first 6 minutes was lower in group P (n11) compared with groups S (n29) and SL (n25)(P0.001). The loss of monitoring time was longer in groups S (62±40 s) and SL (53±39 s) when compared with group P (0 s) (P<0.01). Prone emergence and supine emergence with intravenous lidocaine provides an alternative approach to conventional supine emergence and prone extubation offers less cough and breath holding and continuation of monitoring.