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PEDIATRIC ANESTHESIA

Arterial Carbon Dioxide Markedly Increases During Diagnostic Laparoscopy in Portal Hypertensive Children

Pervin Bozkurt, MD^*, Guner Kaya, MD^*, Yuksel Yeker, MD^*, Nuvit Sarimurat, MD, Ebru Yesildag, MD, Gonca Tekant, MD, Haluk Emir, MD, and Osman Faruk Senyuz, MD

Departments of *Anesthesiology and Pediatric Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey

Address correspondence and reprint requests to Pervin Bozkurt, MD, Istanbul University, Cerrahpasa Medical Faculty, Department of Anesthesiology, 34303, Istanbul, Turkey. Address e-mail to apbs{at}istanbul.edu.tr

Several factors are responsible for hypercarbia during laparoscopic procedures. This study was undertaken because we observed a sudden increase in PaCO₂ in children with portal hypertension (PHT), which was unusual in healthy children undergoing laparoscopic procedures. Fifty-seven children underwent laparoscopic procedures under general anesthesia and were mechanically ventilated. Arterial blood samples were obtained 5 min after intubation (T₀), 15 min and 30 min after CO₂ pneumoperitoneum (T₁₅ and T₃₀), 5 min after desufflation (T_end), and 10 min after extubation (T_ext) for blood gas analysis. The changes in PaCO₂, pH, and ETCO₂ were statistically significant during the study periods in both groups (P < 0.05). The percentage of PaCO₂ increase between T₀ and T₁₅ was 11.5% and 20.1%, respectively, in the control group and the PHT group (P < 0.05). This increase reached 36.8% at T₃₀ in the PHT group, whereas the control group had a 17.2% increase (P < 0.05). ETCO₂ presented similar changes. The variability in base excess, bicarbonate, PaO₂, arterial oxygen saturation, and SpO₂ was not significant in either group (P > 0.05). The PaCO₂ increased remarkably in children with PHT undergoing laparoscopy, with no difference in intrahepatic or extrahepatic origin. Limiting the duration of CO₂ pneumoperitoneum and intraabdominal pressure and adjusting ventilatory variables to accommodate hypercarbia are of the utmost importance for such cases.

IMPLICATIONS: We compared children with portal hypertension with systemically healthy children during laparoscopy. The increase in arterial and end-tidal CO₂ was remarkable in children with portal hypertension, regardless of bicarbonate changes. Managing ventilation to accommodate hypercarbia is of the utmost importance for such cases.

This article has been cited by other articles:

				M. Pacilli, A. Pierro, C. Kingsley, J. I. Curry, J. Herod, and S. Eaton Absorption of carbon dioxide during laparoscopy in children measured using a novel mass spectrometric technique Br. J. Anaesth., August 1, 2006; 97(2): 215 - 219. [Abstract] [Full Text] [PDF]