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Eur J Pediatr Surg
DOI: 10.1055/a-2561-0523
Original Article

Effects of Low-Pressure CO2 Insufflation on Cerebral and Splanchnic Oxygenation in Neonates Undergoing Laparoscopic Pyloromyotomy

Silvia Ceccanti 
1   Department of Maternal Infantile and Urological Sciences, Pediatric Surgery Unit, “Sapienza” University of Rome, AOU Policlinico Umberto I Hospital, Rome, Italy
,
Alice Cervellone
1   Department of Maternal Infantile and Urological Sciences, Pediatric Surgery Unit, “Sapienza” University of Rome, AOU Policlinico Umberto I Hospital, Rome, Italy
,
Oscar Mazzei 
1   Department of Maternal Infantile and Urological Sciences, Pediatric Surgery Unit, “Sapienza” University of Rome, AOU Policlinico Umberto I Hospital, Rome, Italy
,
Maria Vittoria Pesce
2   Department of Anesthesia and Critical Care Medicine, AOU Policlinico Umberto I Hospital, Rome, Italy
,
Denis A. Cozzi 
1   Department of Maternal Infantile and Urological Sciences, Pediatric Surgery Unit, “Sapienza” University of Rome, AOU Policlinico Umberto I Hospital, Rome, Italy
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Abstract

Introduction

Pathophysiological effects of abdominal CO2 insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a paradigm to determine such changes in this specific population.

Material and Methods

Single-center, prospective cohort of 28 infants undergoing laparoscopic pyloromyotomy at the mean age of 30.9 ± 10.6 days. The pneumoperitoneum was set at 6 to 8 mmHg. Regional cerebral oxygen saturation (cSO2) and splanchnic oxygen saturation (sSO2) were measured by near-infrared spectroscopy. End-tidal carbon dioxide (EtCO2) levels, heart rate, body temperature, systemic blood pressure, and urine output were also recorded. Data (mean ± SD) were collected intraoperatively at 0, 15, and 30 minutes and compared to baseline values for each patient using the t-test.

Results

A significant decrease in cSO2 was recorded only at the beginning of surgery, while sSO2 significantly decreased from 15 intraoperative minutes (−7.1% ± 7.2; p = 0.0009) until the end of insufflation, followed by an increasing trend, although still below the baseline values (−6.5% ± 11.2; p = 0.01). EtCO2 increased significantly from the initial 15 intraoperative minutes, reaching a maximum of 42.6 ± 8.9 mmHg at 30-minute intervals. Urine output significantly decreased within the first 4 postoperative hours.

Conclusion

Laparoscopic pyloromyotomy using low-pressure CO2 insufflation (6–8 mmHg) maintains stable cerebral oxygenation in neonates and infants, while splanchnic oxygenation and urine output experience temporary, reversible reductions. These findings suggest that low-pressure pneumoperitoneum is a safe and effective approach in neonatal laparoscopy, with minimal oxygenation and metabolic risks.

Keywords

hypertrophic pyloric stenosis - near-infrared spectroscopy - neonatal surgery - regional oxygen saturation


Publication History

Received: 15 July 2024

Accepted: 14 March 2025

Article published online:
15 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Truchon R. Anaesthetic considerations for laparoscopic surgery in neonates and infants: a practical review. Best Pract Res Clin Anaesthesiol 2004; 18 (02) 343-355
    PubMedSearch in Google Scholar
  • 2 Pacilli M, Pierro A, Kingsley C, Curry JI, Herod J, Eaton S. Absorption of carbon dioxide during laparoscopy in children measured using a novel mass spectrometric technique. Br J Anaesth 2006; 97 (02) 215-219
    PubMedSearch in Google Scholar
  • 3 Laing S, Walker K, Ungerer J, Badawi N, Spence K. Early development of children with major birth defects requiring newborn surgery. J Paediatr Child Health 2011; 47 (03) 140-147
    CrossrefPubMedSearch in Google Scholar
  • 4 Walker K, Halliday R, Holland AJ, Karskens C, Badawi N. Early developmental outcome of infants with infantile hypertrophic pyloric stenosis. J Pediatr Surg 2010; 45 (12) 2369-2372
    PubMedSearch in Google Scholar
  • 5 Cozzi DA, Ceccanti S, Mele E, Frediani S, Totonelli G, Cozzi F. Circumumbilical pyloromyotomy in the era of minimally invasive surgery. J Pediatr Surg 2008; 43 (10) 1802-1806
    PubMedSearch in Google Scholar
  • 6 Ceccanti S, Mele E, Frediani S. et al. Moving toward laparoscopic pyloromyotomy: an initial Italian experience and national survey. Am Surg 2013; 79 (09) 955-958
    PubMedSearch in Google Scholar
  • 7 Hall NJ, Pacilli M, Eaton S. et al. Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 2009; 373 (9661) 390-398
    PubMedSearch in Google Scholar
  • 8 Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997; 23 (03) 293-297
    PubMedSearch in Google Scholar
  • 9 McHoney M, Corizia L, Eaton S. et al. Carbon dioxide elimination during laparoscopy in children is age dependent. J Pediatr Surg 2003; 38 (01) 105-110 , discussion 105–110
    PubMedSearch in Google Scholar
  • 10 Bishay M, Giacomello L, Retrosi G. et al. Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg 2011; 46 (01) 47-51
    PubMedSearch in Google Scholar
  • 11 Dotta A, Rechichi J, Campi F. et al. Effects of surgical repair of congenital diaphragmatic hernia on cerebral hemodynamics evaluated by near-infrared spectroscopy. J Pediatr Surg 2005; 40 (11) 1748-1752
    PubMedSearch in Google Scholar
  • 12 Romeo DM, Betta P, Sanges G, Di Benedetto V, Astuto M, Romeo MG. Cerebral hemodynamics and major surgery. Minerva Pediatr 2007; 59 (03) 233-237
    PubMedSearch in Google Scholar
  • 13 Westgarth-Taylor C, de Lijster L, van Bogerijen G, Millar AJ, Karpelowsky J. A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy. Surg Endosc 2013; 27 (10) 3696-3704
    PubMedSearch in Google Scholar
  • 14 Kamata M, Hakim M, Walia H, Tumin D, Tobias JD. Changes in cerebral and renal oxygenation during laparoscopic pyloromyotomy. J Clin Monit Comput 2020; 34 (04) 699-703
    PubMedSearch in Google Scholar
  • 15 Khoury W, Szold A, Klausner JM, Weinbroum AA. The hemodynamic effects of CO2-induced pressure on the kidney in an isolated perfused rat kidney model. Surg Laparosc Endosc Percutan Tech 2008; 18 (06) 573-578
    PubMedSearch in Google Scholar
  • 16 Martini S, Corvaglia L. Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives. J Perinatol 2018; 38 (05) 431-443
    PubMedSearch in Google Scholar
  • 17 Kopitkó C, Medve L, Gondos T, Soliman KMM, Fülöp T. Mediators of regional kidney perfusion during surgical pneumo-peritoneum creation and the risk of acute kidney injury-a review of basic physiology. J Clin Med 2022; 11 (10) 2728
    CrossrefPubMedSearch in Google Scholar
  • 18 Windberger U, Siegl H, Woisetschläger R, Schrenk P, Podesser B, Losert U. Hemodynamic changes during prolonged laparoscopic surgery. Eur Surg Res 1994; 26 (01) 1-9
    PubMedSearch in Google Scholar
  • 19 Lee BR, Cadeddu JA, Molnar-Nadasdy G. et al. Chronic effect of pneumoperitoneum on renal histology. J Endourol 1999; 13 (04) 279-282
    PubMedSearch in Google Scholar
  • 20 Wever KE, Bruintjes MH, Warlé MC, Hooijmans CR. Renal perfusion and function during pneumoperitoneum: a systematic review and meta-analysis of animal studies. PLoS One 2016; 11 (09) e0163419
    CrossrefPubMedSearch in Google Scholar
  • 21 Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo JA, Koutsogiannaki S. Pediatric perioperative stress responses and anesthesia. Transl Perioper Pain Med 2017; 2 (01) 1-12
    PubMedSearch in Google Scholar
  • 22 Gómez Dammeier BH, Karanik E, Glüer S. et al. Anuria during pneumoperitoneum in infants and children: a prospective study. J Pediatr Surg 2005; 40 (09) 1454-1458
    PubMedSearch in Google Scholar
  • 23 Lau PE, Cruz S, Garcia-Prats J. et al. Use of renal near-infrared spectroscopy measurements in congenital diaphragmatic hernia patients on ECMO. J Pediatr Surg 2017; 52 (05) 689-692
    PubMedSearch in Google Scholar