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The effect of insufflation pressure on pulmonary mechanics in infants during laparoscopic surgical procedures
Author(s) -
Bannister Carolyn F.,
Brosius Keith K.,
Wulkan Mark
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.1460-9592.2003.01149.x
Subject(s) - medicine , anesthesia , insufflation , tidal volume , pneumoperitoneum , respiratory physiology , peak inspiratory pressure , inhalation , sevoflurane , respiratory rate , respiratory system , surgery , laparoscopy , heart rate , blood pressure
Summary Background Few studies have reported objective measurements of pulmonary changes under controlled conditions in infants undergoing laparoscopic procedures. We objectively measured the pulmonary effects of laparoscopically‐induced pneumoperitoneum in infants less than 1 year of age undergoing surgical procedures under general anaesthesia. Methods Nineteen ASA I‐II patients less than 1 year of age were enrolled in this direct observational study. Anaesthetic technique included inhalation induction using sevoflurane/O 2 /air and neuromuscular blockade. Infants were ventilated using 10–15 ml·kg −1 tidal volume at a respiratory rate sufficient to achieve normocarbia [P E CO 2 4.6–5.8 kPa (35–45 mmHg)]. Opioids and regional anaesthesia techniques were used when appropriate. Peak inspiratory pressure (PIP), expiratory tidal volume (Vt), endtidal carbon dioxide concentration (P E CO 2 ) and dynamic compliance (COMPdyn) were recorded at baseline, 5, 10 mmHg and maximal insufflation pressure ( P max ). P max was limited to 12 mmHg for infants <5 kg, 15 mmHg for infants >5 kg. At steady state P max , ventilator changes were implemented to restore Vt and P E CO 2 to within 10% of baseline. Each patient served as his own control. Results At P max , average PIP increased 18%, average Vt decreased 33%, average P E CO 2 concentration increased 13%, average COMPdyn decreased 48%; O 2 saturation fell in 41% of patients. Twenty ventilator adjustments were required; one patient experienced no changes in measured pulmonary mechanics, requiring no ventilator changes. Conclusions Pulmonary mechanics in infants change significantly during laparoscopic CO 2 pneumoperitoneum; the magnitude of change correlates directly with intraperitoneal pressure. Greater than 90% of infants required at least one ventilatory intervention to restore baseline Vt and P E CO 2 .