title: Brain oxygenation during laparoscopic correction of hypertrophic pyloric stenosis.
abstract: BACKGROUND
  Concern remains about the safety of carbon dioxide (CO2) pneumoperitoneum (PP) in young infants having surgery for pyloric stenosis via laparoscopy. Interests here mainly focus on possible jeopardized organ perfusion and in particular brain oxygenation with possible adverse neurodevelopmental outcomes. The aim of this study was to investigate the intraoperative effects of CO2 gas PP on cerebral oxygenation during laparoscopic surgery for hypertrophic pyloric stenosis in young infants.
  
  
  METHODS
  In this single-center prospective observational study, we investigated brain oxygenation in 12 young infants receiving laparoscopic pyloromyotomy with CO2 PP, with a pressure of 8 mm Hg and a flow rate of 5 L/minute. Intraoperative hemodynamic parameters and transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2) were monitored continuously during the whole procedure. Parameters were analyzed in four intervals: before insufflation (T0), during (start [T1] and end [T2]), and after cessation (T3) of the CO2 PP.
  
  
  RESULTS
  Blood pressure and end-tidal CO2 (etCO2) increased during the procedure: mean arterial pressure, 35±5 mm Hg at T0 to 43±9 mm Hg at T2; etCO2, 35±4 mm Hg at T0 to 40±3 mm Hg at T3. The rScO2 remained stable throughout the whole anesthetic period. In none of the patients did the rScO2 drop below the safety threshold of 55% (rScO2, 68±14% at T0 to 71±9% at T3).
  
  
  CONCLUSIONS
  Our results indicate that a laparoscopic procedure with a CO2 PP of 8 mm Hg can be performed under safe anesthetic conditions in the presence of gradually increasing blood pressure and etCO2 without altering regional brain oxygenation levels.
authors.affiliation: 1 Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands .
authors.forename: Stefaan H A J
authors.initials: SH
authors.lastname: Tytgat
authors.forename: Lisanne J
authors.initials: LJ
authors.lastname: Stolwijk
authors.forename: Kristin
authors.initials: K
authors.lastname: Keunen
authors.forename: Dan M J
authors.initials: DM
authors.lastname: Milstein
authors.forename: Petra M A
authors.initials: PM
authors.lastname: Lemmers
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D002245:Carbon Dioxide / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen