Related Experiment Video
Updated: Apr 16, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Brain oxygenation during laparoscopic correction of hypertrophic pyloric stenosis
Stefaan H A J Tytgat1, Lisanne J Stolwijk, Kristin Keunen
11 Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands .
Insights
Carbon dioxide pneumoperitoneum (PP) during laparoscopic pyloromyotomy in infants is safe. Cerebral oxygenation remained stable, showing no adverse effects on brain oxygen levels during the procedure.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Care
Background:
- Safety concerns exist regarding carbon dioxide (CO2) pneumoperitoneum (PP) in infants undergoing laparoscopic surgery for pyloric stenosis.
- Particular attention is paid to potential impacts on organ perfusion and cerebral oxygenation, with implications for neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the intraoperative effects of CO2 PP on cerebral oxygenation in infants undergoing laparoscopic surgery for hypertrophic pyloric stenosis.
Main Methods:
- A prospective observational study monitored brain oxygenation in 12 infants during laparoscopic pyloromyotomy with CO2 PP (8 mm Hg).
- Hemodynamic parameters and regional cerebral oxygen saturation (rScO2) were continuously assessed using transcranial near-infrared spectroscopy.
- Data were analyzed across four intervals: pre-insufflation, during insufflation (start and end), and post-cessation.
Main Results:
- Mean arterial pressure and end-tidal CO2 (etCO2) showed gradual increases during the procedure.
- Regional cerebral oxygen saturation (rScO2) remained stable throughout the entire anesthetic period.
- No patient experienced a drop in rScO2 below the safety threshold of 55%.
Conclusions:
- Laparoscopic pyloromyotomy using CO2 PP at 8 mm Hg is safe in infants.
- The procedure can be performed under safe anesthetic conditions, with stable regional brain oxygenation despite rising blood pressure and etCO2.
Background:
Concern remains about the safety of carbon dioxide (CO2) pneumoperitoneum (PP) in young infants having surgery for pyloric stenosis via laparoscopy. Interests here mainly focus on possible jeopardized organ perfusion and in particular brain oxygenation with possible adverse neurodevelopmental outcomes. The aim of this study was to investigate the intraoperative effects of CO2 gas PP on cerebral oxygenation during laparoscopic surgery for hypertrophic pyloric stenosis in young infants.
Patients And Methods:
In this single-center prospective observational study, we investigated brain oxygenation in 12 young infants receiving laparoscopic pyloromyotomy with CO2 PP, with a pressure of 8 mm Hg and a flow rate of 5 L/minute. Intraoperative hemodynamic parameters and transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2) were monitored continuously during the whole procedure. Parameters were analyzed in four intervals: before insufflation (T0), during (start [T1] and end [T2]), and after cessation (T3) of the CO2 PP.
Results:
Blood pressure and end-tidal CO2 (etCO2) increased during the procedure: mean arterial pressure, 35±5 mm Hg at T0 to 43±9 mm Hg at T2; etCO2, 35±4 mm Hg at T0 to 40±3 mm Hg at T3. The rScO2 remained stable throughout the whole anesthetic period. In none of the patients did the rScO2 drop below the safety threshold of 55% (rScO2, 68±14% at T0 to 71±9% at T3).
Conclusions:
Our results indicate that a laparoscopic procedure with a CO2 PP of 8 mm Hg can be performed under safe anesthetic conditions in the presence of gradually increasing blood pressure and etCO2 without altering regional brain oxygenation levels.
