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PEDIATRIC ANESTHESIA

The Effect of Insufflation Pressure on CO₂ Pneumoperitoneum and Embolism in Piglets

David S. Beebe, MD^*, Shoumin Zhu, MD PhD^*, M. V. Shailesh Kumar, PhD^*, Vijaya Komanduri, MS^*, John A. Reichert, MD, and Kumar G. Belani, MBBS MS^*

Departments of *Anesthesiology, Obstetrics and Gynecology, and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; and Department of Anesthesiology, University of California Medical School, San Francisco, California

Address correspondence and reprint requests to David S. Beebe, MD, Professor, Department of Anesthesiology, University of Minnesota Medical School, MMC 294, B515 Mayo Memorial Building, 420 Delaware St. S.E., Minneapolis, MN 55435. Address e-mail to beebe001{at}tc.umn.edu

We conducted this study to investigate the effect of insufflation pressure on the pathophysiology of CO₂ pneumoperitoneum and embolism in an infant model. Twenty anesthetized piglets had stepwise intraperitoneal insufflation with CO₂ for 15 min at pressures ranging from 5 to 20 mm Hg. The piglets were ventilated to baseline normocarbia (ETCO₂ = 30 mm Hg, PaCO₂ = 38 mm Hg) before beginning each insufflation. CO₂ was then insufflated IV in 15 of these piglets at the same pressures. There was no reduction of blood pressure or cardiac output with intraperitoneal insufflation, but the stroke volume declined significantly (*P < 0.05) from (mean ± SE) 10.6 ± 1.3 mL to 8.5 ± 1.3* mL and from 10.0 ± 1.4 mL to 7.2 ± 1.2* mL at 15 and 20 mm Hg insufflation pressure, respectively. Abdominal insufflation at 5, 10, 15, and 20 mm Hg caused an increase in ETCO₂ to 31.7 ± 0.8 mm Hg, 35.6 ± 1.2* mm Hg, 37.5 ± 1.5* mm Hg, and 40.1 ± 1.8* mm Hg and in PaCO₂ to 41.1 ± 1.3* mm Hg, 44.2 ± 1.4* mm Hg, 49.9 ± 1.8* mm Hg, and 53.0 ± 2.1* mm Hg, respectively. In contrast, the ETCO₂decreased to 19.4 ± 1.5* mm Hg, 20.4 ± 1.4 mm Hg, 15.2 ± 2.1* mm Hg, and 10.6 ± 2.0* mm Hg with IV insufflation using the same pressures. IV insufflation caused marked hypotension and mortality. As the insufflation pressure increased, the mortality increased (0 in 15, 1 in 15, 1 in 14, and 6 in 13* at 5, 10, 15, and 20 mm Hg; *P < 0.05 vs 0 in 15, 1 in 15, and 1 in 14). This study suggests that although intraperitoneal insufflation up to 20 mm Hg may be tolerated hemodynamically, the lowest possible pressure should be used to reduce hypercarbia. A low insufflation pressure may also prevent mortality from CO₂ embolism.

IMPLICATIONS: The lowest pressure possible should be used when inflating the abdomen with CO₂ to perform a laparoscopy in babies. A low pressure allows better ventilation and may prevent mortality if CO₂ is accidentally injected into a vein.

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				Minerva BMJ, June 15, 2002; 324(7351): 1464 - 1464. [Full Text] [PDF]