Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Br J Anaesth. 2010 Feb;104(2):224-7. doi: 10.1093/bja/aep358. Epub 2009 Dec 22.
Laparoscopic interventions in children gain increasing popularity. Pneumoperitoneum as applied during laparoscopic surgery can induce gas emboli formation, but it is unclear whether this is associated with cerebral embolic events. To investigate the hypothesis that pneumoperitoneum causes cerebral emboli in children, the number and intensity of high-intensity transient signals (HITS) detected using transcranial Doppler ultrasonography were assessed before and after induction of pneumoperitoneum.
Twenty children were monitored during laparoscopic surgery. General anaesthesia was performed using sevoflurane and sufentanil or alfentanil. Pressure-controlled ventilation was adapted to maintain end-tidal Pco(2) (Pe'(co(2))) between 4.7 and 6.0 kPa. Baseline measurement of HITS rate, cerebral blood flow velocity, and mean arterial pressure (MAP) were recorded during steady-state anaesthesia before skin incision and during pneumoperitoneum with intra-abdominal pressure of 1.6-2.0 kPa applied using CO(2).
In 14 children (70%), HITS were detected during baseline and pneumoperitoneum. Three additional children (15%) developed HITS during pneumoperitoneum only and another three children (15%) presented no HITS during the investigation period. MAP and cerebral blood flow velocity increased with pneumoperitoneum.
HITS are present in 70% of paediatric surgical patients under balanced anaesthesia before surgical interventions. Pneumoperitoneum further increased the occurrence of HITS.
腹腔镜介入在儿童中越来越受欢迎。腹腔镜手术中应用的气腹会引起气体栓塞的形成，但目前尚不清楚这是否与脑栓塞事件有关。为了验证气腹会导致儿童脑栓塞的假说，本研究通过经颅多普勒超声评估气腹前后高强度短暂信号（HITS）的数量和强度。
本研究对 20 例接受腹腔镜手术的儿童进行了监测。全身麻醉采用七氟醚和舒芬太尼或阿芬太尼。压力控制通气适应以维持呼气末 Pco(2)（Pe'(co(2))) 在 4.7-6.0 kPa 之间。在皮肤切开前和腹腔内压力为 1.6-2.0 kPa 时应用 CO(2)时，记录气腹期间的 HITS 率、脑血流速度和平均动脉压（MAP）的基线测量值。
在 14 名儿童（70%）中，在基线和气腹期间均检测到 HITS。另外 3 名儿童（15%）仅在气腹期间出现 HITS，另有 3 名儿童（15%）在整个研究期间均未出现 HITS。MAP 和脑血流速度随着气腹的增加而增加。
在手术干预前接受平衡麻醉的儿科手术患者中，70%存在 HITS。气腹进一步增加了 HITS 的发生。
