Short- and Long-Term Consequences of CO2 Pneumoperitoneum Impact on Children’s Health

Amirkhan K. Baimaganbetov, Michael M. Stark, Andrea Tinelli, Ospan A. Mynbaev

2022

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DOI 10.5152/tjar.2021.21193
Data confidence 70 medium
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Abstract

We read with great interest the article by Kln et al 1 and we congratulate the authors for a well-designed prospective, observational study. The authors perioperatively monitored the regional splanchnic saturation (rSPcO 2 ), regional cerebral oxygen saturation (rScO 2 ), peripheral oxygen saturation (SpO 2 ), end-tidal CO 2 (Et-CO 2 ), heart rate, mean arterial pressure, and CO 2 insufflation pressure (IP) during laparoscopic surgery in children. An increased Et-CO 2 was associated with decreased regional oxygen saturation parameters (rSPcO 2 and rScO 2 ) during laparoscopic surgery with CO 2 pneumoperitoneum. We also observed analogously increased Et-CO 2 in children during laparoscopic surgery 2 associated with slight blood gas values and acid-base balance changes, associated with decreased skin temperature and urine output. We also found increased concentrations of pCO 2 in the carotid venous and peripheral ear arterial blood with increased venous-to-arterial differences of CO 2 tension with lower pH and tissue acidosis during CO 2 pneumoperitoneum in the rabbit model. These experimental results are certainly meaningful for paediatric surgery as there is a correlation among this model to physiological changes in children and therefore decreased regional oxygen saturation might be associated with increased CO 2 concentrations with lower pH and tissue acidosis in these regions. We believe that such decreased regional oxygen saturation in different locations is an important outcome of this study, 1 and all these changes are the only shortterm impact of CO 2 pneumoperitoneum. Possible future consequences of decreased cerebral oxygen saturation and tissue acidosis might influence postoperative cognitive function. 6] Children and adults are vulnerable to post-surgical complications. It is very difficult to learn the postoperative cognitive function in paediatric patients; therefore, further observations of children after such surgical treatment are needed to study the long-term consequences of CO 2 pneumoperitoneum and general anaesthesia.