Lung compliance during laparoscopic surgery in paediatric patients

Insufflation of CO2 and positioning of patients induces changes in cardiovascular and respiratory function during laparoscopic procedures. This study was initiated to assess respiratory mechanics such as lung compliance and peak airway pressure (PIP) during laparoscopic surgery in paediatric patients. Ten consecutive patients (age 1-15 years) scheduled for laparoscopic procedure were included in this open prospective single-group study. Anaesthesia was induced and maintained with intravenous infusions of propofol and alfentanil. Vecuronium was administered to maintain muscle relaxation. Head down tilt induced a mean decrease of 17% in lung compliance, which was further decreased by 27% from the baseline during insufflation of intraabdominal CO2 (intraabdominal pressure 12 mmHg). Coincidently, PIP increased by 19% and 32% from the baseline during Trendelenburg position and peritoneal insufflation. Lung compliance and PIP returned to their respective baseline values after removal of CO2 from the peritoneal cavity. Endtidal CO2 increased from a baseline value of 4.3 kPa to 5.4 kPa (33-42 mmHg) during surgery when ventilator settings were not altered. We conclude that insufflation of CO2 induces significant increases in peak airway pressure with simultaneous decreases in lung compliance.