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Arterial carbon dioxide markedly increases during diagnostic laparoscopy in portal hypertensive children
Pervin Bozkurt1, Guner Kaya, Yuksel Yeker
1Department of Anesthesiology, Istanbul University, Cerrahpasa Medical Faculty, 34303 Istanbul, Turkey. apbs@istanbul.edu.tr
Insights
Children with portal hypertension experience significantly higher carbon dioxide levels during laparoscopic surgery. Careful ventilation management is crucial to address this hypercarbia in PHT patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Hypercarbia is a known complication of laparoscopic procedures.
- Children with portal hypertension (PHT) exhibit an unusual increase in PaCO(2) during laparoscopy.
Purpose of the Study:
- To investigate the significant increase in PaCO(2) observed in children with PHT during laparoscopic procedures.
- To compare the degree of hypercarbia in children with PHT versus healthy children undergoing laparoscopy.
Main Methods:
- Fifty-seven children undergoing laparoscopic procedures were divided into PHT and control groups.
- Arterial blood gas analysis was performed at multiple time points: pre-intubation, post-CO(2) pneumoperitoneum, post-desufflation, and post-extubation.
- PaCO(2), pH, and ETCO(2) were measured and compared between groups.
Main Results:
- A statistically significant increase in PaCO(2) and ETCO(2) was observed in both groups, but was markedly higher in the PHT group.
- The percentage increase in PaCO(2) at 15 and 30 minutes after CO(2) pneumoperitoneum was significantly greater in the PHT group compared to controls.
- No significant differences were found in base excess, bicarbonate, PaO(2), or oxygen saturation between groups.
Conclusions:
- Children with PHT experience a remarkable increase in arterial and end-tidal CO(2) during laparoscopy, irrespective of the origin of PHT.
- Effective management of ventilation to accommodate hypercarbia is critical for pediatric patients with PHT undergoing laparoscopic surgery.
- Limiting pneumoperitoneum duration and intraabdominal pressure may be beneficial.
Unlabelled:
Several factors are responsible for hypercarbia during laparoscopic procedures. This study was undertaken because we observed a sudden increase in PaCO(2) in children with portal hypertension (PHT), which was unusual in healthy children undergoing laparoscopic procedures. Fifty-seven children underwent laparoscopic procedures under general anesthesia and were mechanically ventilated. Arterial blood samples were obtained 5 min after intubation (T(0)), 15 min and 30 min after CO(2) pneumoperitoneum (T(15) and T(30)), 5 min after desufflation (T(end)), and 10 min after extubation (T(ext)) for blood gas analysis. The changes in PaCO(2), pH, and ETCO(2) were statistically significant during the study periods in both groups (P < 0.05). The percentage of PaCO(2) increase between T(0) and T(15) was 11.5% and 20.1%, respectively, in the control group and the PHT group (P < 0.05). This increase reached 36.8% at T(30) in the PHT group, whereas the control group had a 17.2% increase (P < 0.05). ETCO(2) presented similar changes. The variability in base excess, bicarbonate, PaO(2), arterial oxygen saturation, and SpO(2) was not significant in either group (P > 0.05). The PaCO(2) increased remarkably in children with PHT undergoing laparoscopy, with no difference in intrahepatic or extrahepatic origin. Limiting the duration of CO(2) pneumoperitoneum and intraabdominal pressure and adjusting ventilatory variables to accommodate hypercarbia are of the utmost importance for such cases.
Implications:
We compared children with portal hypertension with systemically healthy children during laparoscopy. The increase in arterial and end-tidal CO(2) was remarkable in children with portal hypertension, regardless of bicarbonate changes. Managing ventilation to accommodate hypercarbia is of the utmost importance for such cases.