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British Journal of Anaesthesia, 2003, Vol. 90, No. 6 733-736
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Left ventricular regional wall motion abnormalities during pneumoperitoneum in children

E. Huettemann1, S. G. Sakka1, G. Petrat1, F. Schier2 and K. Reinhart1

1 Department of Anaesthesiology and Intensive Care Medicine and 2 Department of Paediatric Surgery, Friedrich-Schiller-University Jena, Bachstrasse 18, D-07740 Jena, Germany

Corresponding author. E-mail: Egbert.Huettemann@med.uni-jena.de

Background. In adult patients, certain levels of PEEP (16 and 20 cm H2O) have been associated with left ventricular (LV) regional wall motion abnormalities. Since any increase in intra-abdominal pressure (IAP) exerted by a pneumoperitoneum is transmitted to the intrathoracic cavity, similar effects on LV regional wall motion cannot be ruled out.

Methods. To investigate the effects of pneumoperitoneum on LV regional wall motion, we performed a post hoc analysis of a transoesophageal echocardiography study in eight small children (mean age 3 yr, range 15–63 months) undergoing laparoscopic herniorrhaphy under anaesthesia with sevoflurane in nitrous oxide/oxygen and a PEEP of 5 cm H2O. During carbon dioxide insufflation, end-tidal carbon dioxide concentration was kept constant by increasing minute volume.

Results. An IAP of 12 mm Hg caused significant septal hypokinesia compared with baseline, while anterior and posterior wall motion was not affected. In addition, a lateral hyperkinesia occurred, though this change was not statistically significant.

Conclusions. Pneumoperitoneum may affect LV regional wall motion in paediatric patients undergoing laparoscopic surgery.

Br J Anaesth 2003; 90: 733–6


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