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BJA Advance Access published online on May 23, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael134
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted April 23, 2006

Clinical Investigation

Absorption of carbon dioxide during laparoscopy in children measured using a novel mass spectrometric technique

M. Pacilli 1, A. Pierro 1, C. Kingsley 1, J. I. Curry 1, J. Herod 2, and S. Eaton 1 *

1 Department of Surgery, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
2 Department of Anaesthetics, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK

* To whom correspondence should be addressed.
S. Eaton, E-mail: s.eaton{at}ich.ucl.ac.uk


  Abstract

Background. Carbon dioxide (CO2) is absorbed during pneumoperitoneum and may cause adverse haemodynamic effects. The aim of this study was to measure the elimination of exogenous CO2 during laparoscopy in children.

Methods. Ten children [27.6 (56.5) months; mean (SD)] undergoing laparoscopic and nine [24.5 (17.3) months] undergoing open surgery were studied. Breath samples were collected at the line for end-tidal CO2 and analysed for 13CO2/12CO2 ratio expressed as {delta}PDB (difference from standard), by isotope-ratio mass spectrometry. The proportion of absorbed CO2 was calculated comparing exhaled 13CO2/12CO2 before and during CO2 pneumoperitoneum.

Results. 13CO2/12CO2 in medical CO2 was -32.7 (2.1) {delta}PDB. 13CO2/12CO2 in breath of patients undergoing open procedures was -24.3 (2.4) {delta}PDB at the start of operation and did not change during the operation (P > 0.2). 13CO2/12CO2 in breath of patients undergoing laparoscopy was -21.5 (5.4) {delta}PDB at the start of insufflation, and decreased during pneumoperitoneum by 2.5 (1.6) {delta}PDB, indicating absorption of exogenous CO2. The percentage of expired CO2 absorbed rose to 15.5 (7.7)% after 30 min of pneumoperitoneum and decreased rapidly after desufflation.

Conclusion. After 10 min of laparoscopy 10-20% of expired CO2 derives from the exogenous CO2. CO2 absorption can be measured using a simple mass spectrometric technique.

Keywords: carbon dioxide, absorption; pneumoperitoneum; procedure, mass spectrometry; surgery, laparoscopy.
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