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Haemodynamic changes during low-pressure carbon dioxide pneumoperitoneum in young children
1Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. edewaal@worldonline.nl
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 degrees ). 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 PetCO2 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, PetCO2 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 x min-1 x m2 (P < 0.01), HR increased from 108 +/- 10 to 126 +/- 22 b x 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.