Brain oxygenation during laparoscopic correction of hypertrophic pyloric stenosis

Background: Concern remains about the safety of carbon dioxide (CO2) pneumoperitoneum (PP) in young infants having surgery for pyloric stenosis via laparoscopy. Interests here mainly focus on possible jeopardized organ perfusion and in particular brain oxygenation with possible adverse neurodevelopmental outcomes. The aim of this study was to investigate the intraoperative effects of CO2 gas PP on cerebral oxygenation during laparoscopic surgery for hypertrophic pyloric stenosis in young infants.

Patients and Methods: In this single-center prospective observational study, we investigated brain oxygenation in 12 young infants receiving laparoscopic pyloromyotomy with CO2 PP, with a pressure of 8 mm Hg and a flow rate of 5 L/minute. Intraoperative hemodynamic parameters and transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO(2)) were monitored continuously during the whole procedure. Parameters were analyzed in four intervals: before insufflation (T0), during (start [T1] and end [T2]), and after cessation (T3) of the CO2 PP.

Results: Blood pressure and end-tidal CO2 (etCO(2)) increased during the procedure: mean arterial pressure, 35 +/- 5 mm Hg at T0 to 43 +/- 9 mm Hg at T2; etCO(2), 35 +/- 4 mm Hg at T0 to 40 +/- 3 mm Hg at T3. The rScO(2) remained stable throughout the whole anesthetic period. In none of the patients did the rScO(2) drop below the safety threshold of 55% (rScO(2), 68 +/- 14% at T0 to 71 +/- 9% at T3).

Conclusions: Our results indicate that a laparoscopic procedure with a CO2 PP of 8 mm Hg can be performed under safe anesthetic conditions in the presence of gradually increasing blood pressure and etCO(2) without altering regional brain oxygenation levels.