Authors: De Waal E.E.C.; Kalkman C.J.

Source: Paediatric Anaesthesia, Volume 13, Number 1, January 2003 , pp. 18-25(8)

Publisher: Wiley-Blackwell

Abstract:

Summary

Background: Both mechanical and pharmacological effects may contribute to the haemodynamic consequences of carbon dioxide (CO₂) pneumoperitoneum. The aim of the present study was to evaluate the haemodynamic effects of low-pressure pneumoperitoneum [intra-abdominal pressure (IAP) 5 mmHg] in young children (< 3 years).

Methods: Thirteen children, aged 6–36 months, ASA physical status I–III, who were scheduled for laparoscopic fundoplication for gastro-oesophageal reflux were investigated in the head-up position (10°). Noninvasive thoracic electrical bioimpedance cardiac index (CI), stroke volume index (SVI), heart rate (HR), mean arterial pressure (MAP) and peak inspiratory pressure (PIP) were recorded, together with P etCO₂ and PaCO₂ at five time points: before insufflation, 20, 35 and 70 min after start of CO₂ insufflation and 12 min after desufflation. During insufflation, minute ventilation was not adjusted and the IAP was maintained at 5 mmHg.

Results: During insufflation, P etCO₂ increased from 29 ± 4 to 37 ± 5 mmHg (P < 0.001) and PaCO₂ increased from 31 ± 4 to 39 ± 5 mmHg (P < 0.01). CI increased from 2.39 ± 0.86 to 2.92 ± 0.94 l·min^-1·m² (P < 0.01), HR increased from 108 ± 10 to 126 ± 22 b·min^-1 (P < 0.01), MAP increased from 52 ± 10 to 63 ± 9 (P < 0.05) and PIP increased from 16 ± 3 to 18 ± 3 cm H₂O (P < 0.001). There were no changes in SVI and arterial oxygen saturation.

Conclusions: We conclude that low-pressure CO₂ pneumoperitoneum (with IAPs not exceeding 5 mmHg) for laparoscopic fundoplication in infants and children does not decrease their cardiac index.

Keywords: impedance cardiography; low-pressure pneumoperitoneum; haemodynamic changes; infants

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1460-9592.2003.00973.x

Affiliations: 1: Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands

Publication date: 2003-01-01

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