Cardiocirculatory changes during videolaparoscopy in children: an echocardiographic study

We examined cardiovascular changes associated with intra-abdominal insuffla tion in 20 children (mean age 6.1 +/- 4.7 years, ASA physical status I or I I) undergoing laparoscopic surgery with general anaesthesia using echocardi ography with a transthoracic approach. Intra-abdominal pressure never excee ded 10 mmHg. Systolic blood pressure, diastolic blood pressure, endtidal CO 2, peak, and mean airway pressure increased during intra-abdominal insuffla tion (P < 0.001). Pneumoperitoneum was associated with increases (P < 0.001 ) in left ventricular enddiastolic volume, left ventricular end-systolic vo lume and left ventricular endsystolic meridional wall stress. In addition, before, during and after intra-abdominal insufflation, left ventricular fra ctional shortening and left ventricular ejection fraction, underwent slight , insignificant changes. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular loa d conditions. The sharp increase in intra-abdominal pressure affects both p reload and afterload, while systolic cardiac performance remains unchanged.