Cardiocirculatory changes during videolaparoscopy in children: an echocardiographic study.
We examined cardiovascular changes associated with intra-abdominal insufflation in 20 children (mean age 6.1+/-4.7 years, ASA physical status I or II) undergoing laparoscopic surgery with general anaesthesia using echocardiography with a transthoracic approach. Intra-abdominal pressure never exceeded 10 mmHg. Systolic blood pressure, diastolic blood pressure, endtidal CO2, peak, and mean airway pressure increased during intra-abdominal insufflation (P < 0.001). Pneumoperitoneum was associated with increases (P<0.001) in left ventricular enddiastolic volume, left ventricular end-systolic volume and left ventricular endsystolic meridional wall stress. In addition, before, during and after intra-abdominal insufflation, left ventricular fractional shortening and left ventricular ejection fraction, underwent slight, insignificant changes. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The sharp increase in intra-abdominal pressure affects both preload and afterload, while systolic cardiac performance remains unchanged.
Gentili
A
A
Department of Paediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi Hospital, Bologna, Italy.
Iannettone
C M
CM
Pigna
A
A
Landuzzi
V
V
Lima
M
M
Baroncini
S
S
D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002306:Cardiac Volume / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007327:Insufflation; D010535:Laparoscopy; D008168:Lung / Q000503:physiopathology*; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D012123:Pulmonary Ventilation / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left / Q000502:physiology; D020535:Video-Assisted Surgery
D002245:Carbon Dioxide