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Left ventricular regional wall motion abnormalities during pneumoperitoneum in children
E Huettemann1, S G Sakka, G Petrat
1Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Bachstrasse 18, D-07740 Jena, Germany. Egbert.Huettemann@med.uni-jena.de
Insights
Pneumoperitoneum during laparoscopic surgery in children can cause changes in left ventricular (LV) regional wall motion, specifically septal hypokinesia. This highlights potential cardiac effects in pediatric patients undergoing such procedures.
Area of Science:
- Cardiology
- Pediatric Anesthesiology
- Surgical Innovation
Background:
- Positive end-expiratory pressure (PEEP) above 16 cm H2O is linked to left ventricular (LV) regional wall motion abnormalities in adults.
- Pneumoperitoneum increases intra-abdominal pressure (IAP), which transmits to the intrathoracic cavity, potentially affecting LV function.
Purpose of the Study:
- To investigate the impact of pneumoperitoneum on LV regional wall motion in pediatric patients undergoing laparoscopic surgery.
- To assess changes in LV wall motion during laparoscopic procedures with controlled CO2 insufflation.
Main Methods:
- Post hoc analysis of transesophageal echocardiography data from eight pediatric patients (mean age 3 years).
- Patients underwent laparoscopic herniorrhaphy under sevoflurane anesthesia with a PEEP of 5 cm H2O.
- End-tidal carbon dioxide was maintained constant by adjusting minute volume during CO2 insufflation.
Main Results:
- An intra-abdominal pressure (IAP) of 12 mm Hg induced significant septal hypokinesia compared to baseline.
- Anterior and posterior LV wall motion remained unaffected.
- A trend towards lateral hyperkinesia was observed but did not reach statistical significance.
Conclusions:
- Pneumoperitoneum can influence left ventricular (LV) regional wall motion in pediatric patients during laparoscopic surgery.
- Septal hypokinesia is a notable finding, suggesting potential implications for cardiac function in this population.
Background:
In adult patients, certain levels of PEEP (16 and 20 cm H(2)O) have been associated with left ventricular (LV) regional wall motion abnormalities. Since any increase in intra-abdominal pressure (IAP) exerted by a pneumoperitoneum is transmitted to the intrathoracic cavity, similar effects on LV regional wall motion cannot be ruled out.
Methods:
To investigate the effects of pneumoperitoneum on LV regional wall motion, we performed a post hoc analysis of a transoesophageal echocardiography study in eight small children (mean age 3 yr, range 15-63 months) undergoing laparoscopic herniorrhaphy under anaesthesia with sevoflurane in nitrous oxide/oxygen and a PEEP of 5 cm H(2)O. During carbon dioxide insufflation, end-tidal carbon dioxide concentration ()was kept constant by increasing minute volume.
Results:
An IAP of 12 mm Hg caused significant septal hypokinesia compared with baseline, while anterior and posterior wall motion was not affected. In addition, a lateral hyperkinesia occurred, though this change was not statistically significant.
Conclusions:
Pneumoperitoneum may affect LV regional wall motion in paediatric patients undergoing laparoscopic surgery.