Left ventricular regional wall motion abnormalities during pneumoperitoneum in children.
BACKGROUND
In adult patients, certain levels of PEEP (16 and 20 cm H(2)O) have been associated with left ventricular (LV) regional wall motion abnormalities. Since any increase in intra-abdominal pressure (IAP) exerted by a pneumoperitoneum is transmitted to the intrathoracic cavity, similar effects on LV regional wall motion cannot be ruled out.


METHODS
To investigate the effects of pneumoperitoneum on LV regional wall motion, we performed a post hoc analysis of a transoesophageal echocardiography study in eight small children (mean age 3 yr, range 15-63 months) undergoing laparoscopic herniorrhaphy under anaesthesia with sevoflurane in nitrous oxide/oxygen and a PEEP of 5 cm H(2)O. During carbon dioxide insufflation, end-tidal carbon dioxide concentration ()was kept constant by increasing minute volume.


RESULTS
An IAP of 12 mm Hg caused significant septal hypokinesia compared with baseline, while anterior and posterior wall motion was not affected. In addition, a lateral hyperkinesia occurred, though this change was not statistically significant.


CONCLUSIONS
Pneumoperitoneum may affect LV regional wall motion in paediatric patients undergoing laparoscopic surgery.
Huettemann
E
E
Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Bachstrasse 18, D-07740 Jena, Germany. Egbert.Huettemann@med.uni-jena.de
Sakka
S G
SG
Petrat
G
G
Schier
F
F
Reinhart
K
K
D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D006346:Heart Septum / Q000503:physiopathology*; D006439:Hemodynamics; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D018476:Hypokinesia / Q000209:etiology; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology