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Haemodynamic changes during low‐pressure carbon dioxide pneumoperitoneum in young children
Author(s) -
De Waal E.E.C.,
Kalkman C.J.
Publication year - 2003
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2003.00973.x
Subject(s) - medicine , pneumoperitoneum , insufflation , anesthesia , hemodynamics , cardiac index , peak inspiratory pressure , mean arterial pressure , stroke volume , hypercapnia , respiratory minute volume , heart rate , impedance cardiography , cardiac output , blood pressure , tidal volume , surgery , respiratory system , laparoscopy , acidosis
Summary Background : Both mechanical and pharmacological effects may contribute to the haemodynamic consequences of carbon dioxide (CO 2 ) 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°). 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 P et CO 2 and PaCO 2 at five time points: before insufflation, 20, 35 and 70 min after start of CO 2 insufflation and 12 min after desufflation. During insufflation, minute ventilation was not adjusted and the IAP was maintained at 5 mmHg. Results : During insufflation, P et CO 2 increased from 29 ± 4 to 37 ± 5 mmHg ( P < 0.001) and PaCO 2 increased from 31 ± 4 to 39 ± 5 mmHg ( P < 0.01). CI increased from 2.39 ± 0.86 to 2.92 ± 0.94 l·min −1 ·m 2 ( P < 0.01), HR increased from 108 ± 10 to 126 ± 22 b·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 H 2 O ( P < 0.001). There were no changes in SVI and arterial oxygen saturation. Conclusions : We conclude that low‐pressure CO 2 pneumoperitoneum (with IAPs not exceeding 5 mmHg) for laparoscopic fundoplication in infants and children does not decrease their cardiac index.