Carbon dioxide elimination during laparoscopy in children is age dependent

McHoney, Merrill; Corizia, Lucia; Eaton, Simon; Kiely, Edward M.; Drake, D. P.; Tan, Hock Lim; Spitz, Lewis; Pierro, Agostino

doi:10.1053/jpsu.2003.50021

Cited by 81 publications

(45 citation statements)

References 15 publications

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“…[13][14][15] The peritoneal and pleural absorption surface per unit of weight is high in newborns. 16 The low quantity of peritoneal fat and the slight distance between vessels and the serous surface increase the permeability of the peritoneum to CO 2 . We found that the ETCO 2 was all the more heightened with high-pressure, thoracic, and long-duration insufflation and that a major increase in ETCO 2 was a risk factor for preoperative incident.…”

Section: Discussionmentioning

confidence: 99%

Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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ABSTRACT. Objectives. Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of videosurgery in neonates and to determine the risk factors of per-operative complications.Methods. From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula.Results. Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6°C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O 2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO 2 , surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation.Conclusion. The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. ABBREVIATIONS. ETCO 2 , end-tidal pressure of CO 2 ; O 2 sat, oxygen saturation; HR, heart rate; PIP, peak inflating pressure.

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Section: Discussionmentioning

confidence: 99%

Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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“…CO 2 insufflation could lead to hypoxia, hypercapnea, hemodynamic instability, and acidosis 8,9) because the permeability of CO 2 is high in small children. 9,10) To minimize such risks, lower insufflation pressure (<5 mmHg) has been reported, 6) and we used single-lung ventilation and 4 mm Hg insufflation pressure without complications. In fact, single-lung ventilation allowed excellent exposure despite lower insufflation pressure.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Plication for Diaphragmatic Eventration in a Neonate

Takahashi

Okazaki

Ochi

et al. 2013

ATCS

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Background: Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration. Case Report: A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months. Conclusion: To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.

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“…The elimination of carbon dioxide during and immediately after insufflation with carbon dioxide in children is age and size dependent with the younger and smaller children eliminating more carbon dioxide than older children. The reason for this is not clear but is thought to be because of the different characteristics of their peritoneal surface (McHoney et al, 2003). However, this did not result in any clinically evident effect on the cardiovascular or respiratory system.…”

Section: Respiratory Systemmentioning

confidence: 95%

“…Pacilli et al (2006) demonstrated that in children after 10 -12mins of laparoscopy, 10-20% of expired carbondioxide derived from absorption of exogenous carbon dioxide and continues to be eliminated for up to 30minutes after the end of insufflation. Minute ventilation needs to be www.intechopen.com adjusted in order to avoid hypercarbia.. McHoney et al (2003) observed the elimination of carbon dioxide in children to be age-dependent. The short trachea in children increases the risk of endobronchial intubation.…”

Section: Respiratory Systemmentioning

confidence: 99%