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Absorption of carbon dioxide during laparoscopy in children measured using a novel mass spectrometric technique

M Pacilli1, A Pierro, C Kingsley

  • 1Department of Surgery, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.

British Journal of Anaesthesia
|May 25, 2006
PubMed

Insights

During pediatric laparoscopy, 10-20% of exhaled carbon dioxide (CO(2)) originates from exogenous CO(2) absorption. This CO(2) uptake can be effectively quantified using isotope-ratio mass spectrometry.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Medical Physics

Background:

  • Carbon dioxide (CO(2)) insufflation during laparoscopy can lead to systemic absorption.
  • This absorption may cause adverse hemodynamic effects, particularly in pediatric patients.
  • Quantifying exogenous CO(2) absorption is crucial for understanding its physiological impact.

Purpose of the Study:

  • To measure the elimination and absorption of exogenous carbon dioxide (CO(2)) during laparoscopic surgery in children.
  • To assess the contribution of exogenous CO(2) to end-tidal CO(2) levels during pediatric laparoscopy.
  • To evaluate the feasibility of using isotope-ratio mass spectrometry for this measurement.

Main Methods:

  • A cohort of pediatric patients undergoing laparoscopic surgery was studied, with a control group undergoing open surgery.
  • Breath samples were analyzed for the ratio of carbon-13 to carbon-12 ( (13)CO(2)/(12)CO(2) ) using isotope-ratio mass spectrometry.
  • The proportion of absorbed CO(2) was determined by comparing pre- and intra-procedural breath isotope ratios.

Main Results:

  • Patients undergoing laparoscopy showed a significant decrease in the (13)CO(2)/(12)CO(2) ratio in exhaled breath during pneumoperitoneum, indicating exogenous CO(2) absorption.
  • Approximately 10-20% of expired CO(2) was derived from exogenous sources after 10 minutes of laparoscopic surgery.
  • CO(2) absorption levels peaked at 15.5% after 30 minutes and decreased rapidly upon desufflation.

Conclusions:

  • A significant portion of exhaled CO(2) during pediatric laparoscopy originates from the insufflated gas.
  • Isotope-ratio mass spectrometry provides a reliable method for measuring exogenous CO(2) absorption during laparoscopic procedures.
  • Understanding CO(2) absorption is vital for managing potential hemodynamic complications in pediatric laparoscopic surgery.
Abstract

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