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Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs
M L Metzelder1, J F Kuebler, D Huber
1Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. mmetzelder@yahoo.com
Insights
Prolonged carbon dioxide pneumoperitoneum causes significant hypotension and cardiac depression in neonatal pigs, unlike in adolescents. Intensive monitoring is crucial for neonates undergoing lengthy laparoscopic procedures, especially post-operatively.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Comparative Physiology
Background:
- Minimally invasive procedures are increasingly common for pediatric patients.
- Hemodynamic effects of prolonged carbon dioxide pneumoperitoneum (CO(2) PP) in infants are not well understood.
- This study compares CO(2) PP effects in neonatal and adolescent pigs.
Purpose of the Study:
- To investigate and compare the hemodynamic effects of prolonged CO(2) PP in neonatal and adolescent pigs.
- To assess changes in mean arterial pressure (MAP), central venous pressure (CVP), and cardiac index (CI).
Main Methods:
- Neonatal (n=6) and adolescent (n=6) pigs underwent 180-minute CO(2) PP.
- A control group of neonatal pigs (n=5) underwent sham PP.
- Hemodynamic parameters (MAP, CVP, CI) were monitored during and after CO(2) PP.
Main Results:
- Neonatal pigs experienced significantly greater decreases in MAP during and after CO(2) PP compared to adolescents.
- Neonates showed a more pronounced decrease in CI during the recovery period post-decompression.
- No significant hemodynamic changes were observed in the sham PP control group.
Conclusions:
- Prolonged CO(2) PP induces hypotension and cardiac depression in neonatal pigs.
- Adolescent pigs did not exhibit significant adverse hemodynamic effects.
- Intensive monitoring is essential for neonates during and especially after prolonged laparoscopic procedures.
Background:
Long-lasting minimally invasive procedures are increasingly used for children. However, the hemodynamic effects of a prolonged carbon dioxide (CO(2)) pneumoperitoneum (PP) on small infants are poorly understood and may differ from the effects on adolescents. This study aimed to detect and compare these effects in neonatal and adolescent pigs.
Methods:
Six neonatal pigs weighing 5.6-6.4 kg and six adolescent pigs weighing 51-57 kg underwent a prolonged CO(2) PP of 180 min. Five neonatal pigs weighing 5.7-6.6 kg underwent sham PP as an additional control group. All the animals received crystalloid electrolyte solution at 10 ml/kg/h during the experiments. After CO(2) decompression, all the animals were monitored for a further 120 min. The end points of the study were mean arterial pressure (MAP), central venous pressure (CVP), and cardiac index (CI). The parameters were assessed after a 60-min resting phase (i.e., after initial placement of catheters in the jugular vein, the carotid artery, and the femoral artery four times during CO(2) PP and three times afterward.
Results:
The comparison of neonates and adolescent pigs showed that neonates had a significantly more pronounced decrease in MAP during CO(2) PP (88.1 +/- 2.7% of baseline vs 95.1 +/- 1.6%; p < 0.05) and the recovery period (71 +/- 5.1% vs 86.4 +/- 1.4%; p < 0.05). Differences in CVP changes between the neonatal and adolescent pigs during and after CO(2) PP were not significant. For the neonates, the decrease in CI was most pronounced during the recovery period after decompression of the CO(2) PP and significantly less than in adolescents (84.3 +/- 3.3% of baseline vs 97.4 +/- 4.5%; p < 0.05). The neonates with sham PP did not show any significant MAP, CVP, or CI changes during the experiments.
Conclusions:
A prolonged CO(2) PP induces hypotension and cardiac depression in neonatal but not in adolescent pigs. Thus, intensive monitoring during prolonged laparoscopic procedures and particularly afterward may be mandatory for neonates.
