Carbon dioxide elimination during laparoscopy in children is age dependent

Merrill McHoney, Lucia Corizia, Simon Eaton, Edward M. Kiely, David P. Drake, Hock L. Tan, Lewis Spitz, Agostino Pierro

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

The absorption of carbon dioxide (CO2) used for positive pressure pneumoperitoneum may lead to an increased CO2 load. CO2 elimination during laparoscopy has not been investigated previously in paediatrics. The aim of this study was to characterise the pattern of CO2 elimination during laparoscopic surgery in infants and children. Methods: Twenty children undergoing laparoscopy and 19 children undergoing laparotomy for elective abdominal operations were studied. Pneumoperitoneum was achieved using insufflation of unheated CO2CO2 elimination (metabolically produced + absorbed; milliliters per kilogram per minute) was measured minute by minute during the operation by indirect calorimetry. End-tidal CO2 (kPa) was recorded every 10 minutes. The above variables were assessed before CO2 insufflation, during pneumoperitoneum, and after desufflation. Results: Before insufflation, CO2 elimination was 4.6 ± 0.3 ml/kg/min and increased after 15 minutes of pneumoperitoneum to 5.2 ± 0.3 (P < .001). Post desufflation, CO2 elimination decreased toward preinsufflation values, but did not return to baseline by the end of operation (5.8 ± 0.3; P < .001). End-tidal CO2 was 4.7 ± 0.2 preinsufflation, peaked at 1 hour (5.3 ± 0.2; P < .001) and subsequently decreased in response to ventilatory adjustments. The total amount of CO2 insufflated was positively correlated with patient age (r2 = 0.27; P < .01). CO2 elimination was age related, as indicated by multilevel model analysis and by negative correlations between maximum increase in CO2 elimination and both age (r2 = 0.27; P < .01) and weight (r2 = 0.29; P < .01). These data suggest that the younger or smaller the child, the larger the increase in CO2 elimination. Seven patients (35%) responded to desufflation with a sharp transient increase in CO2 elimination, which did not appear to be related to patient age, length of pneumoperitoneum, abdominal pressure, or type of operation. Conclusions: During pneumoperitoneum, younger children absorb proportionately more CO2 than older individuals. The short-lived increase in CO2 elimination postdesufflation may be related to an increase in venous return from the lower limbs after release of the abdominal pressure. These findings suggest that small children warrant close monitoring during laparoscopy and during the immediate postoperative period.

Original languageEnglish
Pages (from-to)105-110
Number of pages6
JournalJournal of Pediatric Surgery
Volume38
Issue number1
DOIs
Publication statusPublished - 1 Jan 2003
Externally publishedYes

Fingerprint

Pneumoperitoneum
Carbon Dioxide
Laparoscopy
Insufflation
Pressure
Multilevel Analysis
Indirect Calorimetry
Postoperative Period
Laparotomy
Lower Extremity
Pediatrics
Weights and Measures

Keywords

  • Carbon dioxide elimination
  • Indirect calorimetry
  • Laparoscopy
  • Metabolism
  • Paediatrics
  • Pneumperitoneum

ASJC Scopus subject areas

  • Surgery

Cite this

McHoney, M., Corizia, L., Eaton, S., Kiely, E. M., Drake, D. P., Tan, H. L., ... Pierro, A. (2003). Carbon dioxide elimination during laparoscopy in children is age dependent. Journal of Pediatric Surgery, 38(1), 105-110. https://doi.org/10.1053/jpsu.2003.50021

Carbon dioxide elimination during laparoscopy in children is age dependent. / McHoney, Merrill; Corizia, Lucia; Eaton, Simon; Kiely, Edward M.; Drake, David P.; Tan, Hock L.; Spitz, Lewis; Pierro, Agostino.

In: Journal of Pediatric Surgery, Vol. 38, No. 1, 01.01.2003, p. 105-110.

Research output: Contribution to journalArticle

McHoney, M, Corizia, L, Eaton, S, Kiely, EM, Drake, DP, Tan, HL, Spitz, L & Pierro, A 2003, 'Carbon dioxide elimination during laparoscopy in children is age dependent', Journal of Pediatric Surgery, vol. 38, no. 1, pp. 105-110. https://doi.org/10.1053/jpsu.2003.50021
McHoney M, Corizia L, Eaton S, Kiely EM, Drake DP, Tan HL et al. Carbon dioxide elimination during laparoscopy in children is age dependent. Journal of Pediatric Surgery. 2003 Jan 1;38(1):105-110. https://doi.org/10.1053/jpsu.2003.50021
McHoney, Merrill ; Corizia, Lucia ; Eaton, Simon ; Kiely, Edward M. ; Drake, David P. ; Tan, Hock L. ; Spitz, Lewis ; Pierro, Agostino. / Carbon dioxide elimination during laparoscopy in children is age dependent. In: Journal of Pediatric Surgery. 2003 ; Vol. 38, No. 1. pp. 105-110.
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N2 - The absorption of carbon dioxide (CO2) used for positive pressure pneumoperitoneum may lead to an increased CO2 load. CO2 elimination during laparoscopy has not been investigated previously in paediatrics. The aim of this study was to characterise the pattern of CO2 elimination during laparoscopic surgery in infants and children. Methods: Twenty children undergoing laparoscopy and 19 children undergoing laparotomy for elective abdominal operations were studied. Pneumoperitoneum was achieved using insufflation of unheated CO2CO2 elimination (metabolically produced + absorbed; milliliters per kilogram per minute) was measured minute by minute during the operation by indirect calorimetry. End-tidal CO2 (kPa) was recorded every 10 minutes. The above variables were assessed before CO2 insufflation, during pneumoperitoneum, and after desufflation. Results: Before insufflation, CO2 elimination was 4.6 ± 0.3 ml/kg/min and increased after 15 minutes of pneumoperitoneum to 5.2 ± 0.3 (P < .001). Post desufflation, CO2 elimination decreased toward preinsufflation values, but did not return to baseline by the end of operation (5.8 ± 0.3; P < .001). End-tidal CO2 was 4.7 ± 0.2 preinsufflation, peaked at 1 hour (5.3 ± 0.2; P < .001) and subsequently decreased in response to ventilatory adjustments. The total amount of CO2 insufflated was positively correlated with patient age (r2 = 0.27; P < .01). CO2 elimination was age related, as indicated by multilevel model analysis and by negative correlations between maximum increase in CO2 elimination and both age (r2 = 0.27; P < .01) and weight (r2 = 0.29; P < .01). These data suggest that the younger or smaller the child, the larger the increase in CO2 elimination. Seven patients (35%) responded to desufflation with a sharp transient increase in CO2 elimination, which did not appear to be related to patient age, length of pneumoperitoneum, abdominal pressure, or type of operation. Conclusions: During pneumoperitoneum, younger children absorb proportionately more CO2 than older individuals. The short-lived increase in CO2 elimination postdesufflation may be related to an increase in venous return from the lower limbs after release of the abdominal pressure. These findings suggest that small children warrant close monitoring during laparoscopy and during the immediate postoperative period.

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