Arterial carbon dioxide markedly increases during diagnostic laparoscopy in portal hypertensive children Author(s): Bozkurt, P; Kaya, G; Yeker, Y; et al. Source: ANESTHESIA AND ANALGESIA Volume: 95 Issue: 5 Pages: 1236-1240 DOI: 10.1213/01.ANE.0000030426.38778.EB Published: NOV 2002


BOZKURT P. , EMİR H. , SARIMURAT N., ŞENYÜZ O. F. , Yeşildağ E.

ANESTHESIA AND ANALGESIA, vol.95, no.5, pp.1236-1240, 2002 (Journal Indexed in SCI)

  • Publication Type: Article / Article
  • Volume: 95 Issue: 5
  • Publication Date: 2002
  • Title of Journal : ANESTHESIA AND ANALGESIA
  • Page Numbers: pp.1236-1240

Abstract

everal 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 (Tend), and 10 min after extubation (Text) 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 T0and 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 Paco2increased remarkably in children with PHT undergoing laparoscopy, with no difference in intrahepatic or extrahepatic origin. Limiting the duration of CO2pneumoperitoneum and intraabdominal pressure and adjusting ventilatory variables to accommodate hypercarbia are of the utmost importance for such cases.

 

 

The advantages of diagnostic laparoscopy in portal hypertensive (PHT) patients include visual examination of the liver, regional collateralization, and obtaining liver biopsy specimens directly from the nodular structures. However, laparoscopic investigation, which is performed with the use of CO2 insufflation into the peritoneal cavity, is not without potential complications. In 1993, we recognized that the Paco2 levels of PHT patients were remarkably higher than those of systemically healthy children, for instance, patients with undescended testis. Changes in arterial CO2 (Paco2) and the hemodynamic state that occurs during laparoscopic procedures have been extensively studied in adult patients(1,2). Several factors have been considered as responsible for the hypercarbia encountered during diagnostic or interventional laparoscopic procedures. These factors include absorption of CO2 by the peritoneum, alterations in cardiac output and respiratory mechanics and function caused by increased intraabdominal pressure, and cephalad displacement of the diaphragm, resulting in decreases in lung volume and functional residual capacity (1–7). The aim of this study was to verify the differences arising from changes in blood gases in two groups of children undergoing laparoscopic procedures: 1) PHT patients and 2) children who were otherwise in reasonably good health (the control group).