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PEDIATRIC ANESTHESIA

The Effects of Low-Pressure Carbon Dioxide Pneumoperitoneum on Cerebral Oxygenation and Cerebral Blood Volume in Children

Eric E. C. de Waal, MD^*, Jaap W. de Vries, MD PhD^*, Cas L. J. J. Kruitwagen, MSc, and Cor J. Kalkman, MD PhD^*

*Department of Anesthesiology, University Medical Centre Utrecht; and Centre for Biostatistics, Utrecht University, Utrecht, The Netherlands

Address correspondence and reprint requests to Eric E. C. de Waal, MD, Department of Anesthesiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Address e-mail to e.e.c.dewaal{at}azu.nl

We examined the effects of low-pressure carbon dioxide pneumoperitoneum on regional cerebral oxygen saturation (ScO₂) and cerebral blood volume (CBV) in children. Fifteen children, ASA I–III, scheduled for laparoscopic fundoplication, were investigated in the head-up position (10°) and ventilated to a baseline end-tidal CO₂ (PETCO₂) between 25 and 33 mm Hg. Ventilatory settings remained unchanged during the operation. ScO₂ and CBV were assessed with near-infrared spectroscopy and recorded together with end-tidal and arterial carbon dioxide (PaCO₂) at 5 time points: before insufflation, 30, 60, and 90 min after the start of CO₂ insufflation, and 10 min after desufflation. The intraabdominal pressure was kept between 5 and 8 mm Hg. During insufflation, PETCO₂ increased from 30.0 ± 2.8 to 38.3 ± 5.1 mm Hg (P < 0.001) and PaCO₂ increased from 32.0 ± 4.7 to 40.4 ± 5.9 mm Hg (P < 0.001). ScO₂ increased by 15.7% ± 8.8% (from 61 ± 9 to 70 ± 9 arbitrary units ) (P < 0.001). CBV increased by 4.6% ± 8.8% (from 123 ± 66 to 128 ± 66 arbitrary units [P = 0.048]). After desufflation, PETCO₂ and PaCO₂ decreased, but did not return to preinsufflation values. ScO₂ and CBV also decreased after desufflation. In conclusion, hyperventilation and the head-up position before CO₂ insufflation are not sufficient to prevent the CO₂-mediated cerebral hemodynamic effects of low-pressure pneumoperitoneum (5–8 mm Hg) in children.

IMPLICATIONS: Peritoneal CO₂ absorption during laparoscopic surgery causes hypercapnia and CO₂-mediated cerebral hemodynamic effects. Hyperventilation and the head-up position before CO₂ insufflation is not sufficient to counteract these effects of low-pressure pneumoperitoneum (5–8 mm Hg) in children.

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