ABSTRACT
BACKGROUND: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. METHODS: Twenty eight patients were assigned to receive diagnostic laparoscopy (n = 12) or laparoscopic surgery (n = 16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. RESULTS: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P < 0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P < 0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P < 0.05). CONCLUSIONS: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children.
Subject(s)
Child , Humans , Arterial Pressure , Heart Rate , Insufflation , Laparoscopy , Pneumoperitoneum , Respiratory Rate , Tidal VolumeABSTRACT
No presente trabalho foram analisados os efeitos sobre os aparelhos cardiovascular e respiratório da anestesia inalatória com isoflurano em 3 (três) concentrações fixas (1, 1 ,5 e 2 CAM) no cão. Foram utilizados 6 (seis) cães machos, pesando 25 ± 2, 7 kg, com valores hematológicos e bioquímicas dentro da faixa de normalidade. Os parâmetros analisados foram: frequência cardíaca (FC), pressão arterial sistólica (PS), diastólica (PD) e média (PM), débito cardíaco (DC), índice cardíaco (IC), frequência respiratória (FR),volume corrente (VC) e volume minuto (VM). Observou-se que, baixas concentrações de isoflurano (1 e 1,5 CAM) produziram um aumento de FC. Com relação à pressão arterial, verificou-se um decréscimo dose-dependente, causado pela diminuição da resistência vascular periférica, o que explicaria a manutenção do DC e IC em baixas concentrações (1 e 1,5 CAM). A 2 CAM de concentração, o aumento da FC não foi capaz de compensar o menor volume de ejeção do coração. Devido a isso, observou-se queda do DC e IC. No sistema respiratório, encontrou-se diminuição da FR, VC e VM, dose-dependente.
Cardiovascular and pulmonary effexts of isoflurane anesthesia at 1, 1 ,5 and 2 minimum alveolar concentration (MAC) were studies in 6 male dogs, healty, weighting 25 ± 2.7 kg. Heart rate (HR), systolic arterial pressure (SAP), dyastolic arterial pressure rate (RR), tidal volume (TV) and minute ventilation (MV) were measured. Low isoflurane concentrations (1 and 1,5 MAC) increased the heart rate (HR). Arterial blood pressure decreased as the MAC increased, explaining the maintenance of the CO and the Cl at low concentrations of isoflurane (1 and 1,5 MAC). At 2 MAC the increase of the HR is not enough to compensate the low heart stroke volume, soa drop of CO an Cl was obseved. A dose-dependent decrease of the RR, TV and MV was also obseved.