The Effects Of Different CO₂ Pneumoperitoneum Pressure On Infant Resparitory And Circulation In Laparoscopic Surgery

Objective: To observe and investigate the effects of infant respiration and circulation in laparoscopic surgery under different CO2 pneumoperitoneum pressure.Methods: Thirty ASAâ… -â…¡patients less than 1 year of age underwent LCwere randomly divided into two groups with 15 patients in each group. The CO2 pneumoperitoneum pressure was set at 8 mmHg in the Group A.12mmHg in the Group B. All patients received a standardized anaesthetic. When they came into the operation room, the patients were anesthetized with intramuscular injection of MKA 0.1ml/kg (Ketamine 20mg/ml, Midazolam 2mg/ml, Atropine 0.1mg/ml). Anaesthesia induction used MKA 0.05ml/kg, fentant 0.01mg/kg, norcuron 0.1mg/kg, and maintained with sevoflurane 0.75MAC. Surgery was performed in the supine position. All patients underwent mechanical ventilation using volume-controlled mode (initial tidal volume 10-12ml/kg; respiratory rate 24-28/min) to maintain normocapnia .General aneasthesia was maintained with an oxygen/air mixture of 50/50 .A basalâ…£infusion (15-20ml/kg/hr) of lactated Ringer's solution was given to compensate for the fasting state and intraoperativ losses. BP,HR,SpO2,P_ETCO2, PIP,VT,Cdyn,Raw,MV,Ppeak,Pplat were determined at the three time points: 5min before peritoneal insufflation (T₀),10min after peritoneal insufflation (T₁),5min after exsufflation(T₂).Results : Results are summarized in Table 1,2,3,4.(1) The P_ETCO₂ leve in group A and group B at T₁ were no significantly different compared with those at T₀, At T₂ the P_ETCO₂ level in both groups were significantly different compared with those at T0.The PH and PaCO₂ levels in both groups at T₁ were significantly different compared with those at T₀.There were no significant changes in MAP and HR in both groups at T₁ and T₂.(2) The Cdyn,Raw,Ppeak levels in group A at T₁ were no significantly different compared with those at T₀. At T₂ those were no significant changes compared with those at T₀.(3) The Cdyn,Raw,Ppeak levels in group B at T₁ were significantly different compared with those at T₀. At T₂ those were no significant changes compared with those at T₀.(4) The P_ET CO2,Cdyn,Raw,Ppeak,MAP,HR,PH,PaCO2,PaO2,HCO₃^- levels in group A and group B at T₀ were no significantly different.The Cdyn,Raw,Ppeak levels in group B at T₁ have significantly different from group A.Conclusion:1 8mmHg and 12mmHg CO₂ pneumoperitoneum pressure both causedCdyn decrease , PetCO₂,Raw and Ppeak increase.2 8mmHg CO₂ pneumoperitoneum pressure is less likely to effect infant respiratory and hemodynamic than 12mmHg CO₂ pneumoperitoneum pressure. Lower CO₂ pneumoperitoneum pressure is more preferable can be satisfied performed.