Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: A prospective study

Purpose: Our understanding of the effects of retroperitoneal CO2 insufflation on cardiopulmonary variables in children remains limited. This study was designed to investigate prospectively the effect of CO2 insufflation in a pediatric population undergoing retroperitoneal laparoscopic surgery. Materials and Methods: We prospectively evaluated a consecutive series of patients enrolled between July 2003 and August 2004. Anesthesia was administered following a standardized protocol. Data collection included respiratory rate, PAP, O-2 saturation, ETCO2, HR, MAP, electrocardiogram and insufflation pressure. All variables were recorded before, during and after CO2 insufflation at regular intervals of 1 to 2 minutes, with up to 23 measurements recorded for each period. Results: A total of 18 participants were recruited. Mean +/- SD for age and weight were 79.4 +/- 53.2 months and 26.7 +/- 15.5 kg, respectively. Mean retroperitoneal CO2 insufflation pressure was kept at 12 mm Hg. Significant differences (p < 0.05) in average ETCO2, PAP and MAP were noted after CO2 insufflation compared to baseline (pre-pneumoretroperitoneum) values. HR and temperature did not change. At completion of the laparoscopic intervention physiological variables exhibited a trend to return to baseline values. Conclusions: This prospective study documents significant changes in systemic hemodynamic variables that seem to be directly associated with the insufflation of CO2 during pediatric retroperitoneal laparoscopic surgery. This ongoing evaluation confirms the effect of laparoscopic urological surgery and CO2 insufflation on cardiopulmonary function in children.