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PEDIATRIC ANESTHESIA

Preserved CO₂ Reactivity and Increase in Middle Cerebral Arterial Blood Flow Velocity During Laparoscopic Surgery in Children

Egbert Huettemann, MD, DEAA^*, Christoph Terborg, MD, Samir G. Sakka, MD^*, Gritta Petrat, MD^*, Felix Schier, MD, PhD, and Konrad Reinhart, MD, PhD^*

Departments of *Anesthesiology and Intensive Care Medicine, Neurology, and Pediatric Surgery, Friedrich-Schiller-University Jena, Jena, Germany

Address correspondence and reprint requests to Egbert Hüttemann, MD, DEAA, Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena, Bachstrasse 18, D-07740 Jena, Germany. Address e-mail to Egbert.Huettemann{at}med.uni-jena.de

In adult patients, the creation of pneumoperitoneum (PP) by means of carbon dioxide (CO₂) insufflation leads to an increase in cerebral blood flow velocity (CBFV), which is thought to be caused by hypercapnia. We evaluated whether PP leads to an increase of CBFV in children, and whether this increase is directly related to PP. The effects of PP on middle cerebral artery blood flow velocity were investigated in 12 children (mean age 3 yr, range 15–63 mo) undergoing laparoscopic herniorrhaphy under general anesthesia with sevoflurane and nitrous oxide/oxygen. CBFV was measured by using transcranial Doppler ultrasonography. During CO₂ insufflation, the end-tidal CO₂ concentration was kept constant by adjustment of ventilation by increasing minute volume. The CBFV increased significantly at an intraabdominal pressure of 12 mm Hg compared with baseline from 68 ± 11 cm/s to 81 ± 12 cm/s (P < 0.05). CO₂ reactivity remained in the normal range (4.0% ± 1.9%/mm Hg) during PP. We conclude that the induction of PP leads to an increase in middle cerebral artery blood flow velocity in young children independent from hypercapnia, whereas CO₂ reactivity remains normal.

IMPLICATIONS: Laparoscopic surgery is performed frequently in pediatric patients. Cerebral blood flow velocities increase during insufflation of the intraperitoneal cavity for minimally invasive surgery in children. The vasoreactivity as part of the cerebral autoregulation remains unaffected.

This article has been cited by other articles:

				J. L. Zitsman Current Concepts in Minimal Access Surgery for Children Pediatrics, June 1, 2003; 111(6): 1239 - 1252. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999