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Surgical Endoscopy

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01-09-2013 | Dynamic Manuscript

Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy

Authors: Stefaan H. A. J. Tytgat, David C. van der Zee, Can Ince, Dan M. J. Milstein

Published in: Surgical Endoscopy | Issue 9/2013

Abstract

Background

Little is known about the direct effect of pneumoperitoneum (PP) on microcirculation and its influence on the quality of tissue perfusion. This study aimed to investigate the intraoperative effects of carbon dioxide (CO₂) gas PP on microcirculation density and perfusion in neonates receiving laparoscopic surgery for hypertrophic pyloric stenosis.

Methods

In a single-center observational study, the oral microcirculation in 12 neonates receiving laparoscopic pyloromyotomy was investigated. Intraoperative hemodynamic parameters, intermittent buccal mucosa capillary density measurements (pre- and postoperative), and continuous intraoperative sublingual microcirculation measurements (i.e., vessels with a diameter <25 μm) of total vessel density, perfused vessel density, proportion of perfused blood vessels, blood vessel diameters (BVd), and microvascular flow index were obtained before (at baseline), during, and after PP insufflation for all patients using sidestream dark-field imaging for the duration of the complete surgical procedure.

Results

With the exception of a significantly elevated end-tidal CO₂ (34 ± 4–40 ± 8 mmHg; p < 0.05 vs before [baseline], one-way analysis of variance [ANOVA]) during intraoperative insufflation, no significant differences were found between time points for the intraoperative hemodynamic parameters. Pre- and postoperative buccal capillary density showed no significant changes in mucosal perfusion. Analysis of continuous intraoperative sublingual microcirculation parameters exhibited a statistically significant increase in BVd during insufflation (8.8 ± 2.4–9.3 ± 2.5 μm; p < 0.05, one-way ANOVA) and a significant decrease after exsufflation (8.2 ± 2.3 μm; p < 0.01 vs during insufflation and p < 0.05 vs baseline, one-way ANOVA, respectively). No other significant differences were found between time points for the remaining microcirculatory parameters.

Conclusion

The installation of CO₂ gas PP during laparoscopic pyloromyotomy procedures regulates microcirculatory perfusion by inducing changes in microvascular diameters but does not alter microcirculation density in neonates.

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te Velde EA, Bax NM, Tytgat SH, de Jong JR, Vieira Travassos D, Kramer WL, van der Zee DC (2008) Minimally invasive pediatric surgery: increasing implementation in daily practice and resident’s training. Surg Endosc 22:163–166CrossRef

Bishay M, Giacomello L, Retrosi G, Thyoka M, Nah SA, McHoney M, De Coppi P, Brierley J, Scuplak S, Kiely EM, Curry JI, Drake DP, Cross KMK, Eaton S, Pierro A (2011) Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg 46:47–51PubMedCrossRef

Yürük K, Milstein DM, Bezemer R, Bartels SA, Biemond BJ, Ince C (2012) Transfusion of banked red blood cells and the effects on hemorrheology and microvascular hemodynamics in anemic hematology outpatients. Transfusion. doi:10.1111/j.1537-2995.2012.03905.x

Atasever B, Boer C, Speekenbrink R, Seyffert J, Goedhart P, de Mol B, Ince C (2011) Cardiac displacement during off-pump coronary bypass grafting surgery: effect on sublingual microcirculation and cerebral oxygenation. Interact Cardiovasc Thorac Surg 13:573–577PubMedCrossRef

Atasever B, Boer C, Goedhart P, Biervliet J, Seyffert J, Speekenbrink R, Schwarte L, de Mol B, Ince C (2011) Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 25:784–790PubMedCrossRef

De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Care Med 166:98–104CrossRef

Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831PubMedCrossRef

Ince C (2005) The microcirculation is the motor of sepsis. Crit Care 9:S13–S19PubMedCrossRef

Milstein DM, Bezemer R, Lindeboom JA, Ince C (2009) The acute effects of CMF-based chemotherapy on maxillary periodontal microcirculation. Cancer Chemother Pharmacol 64:1047–1052PubMedCrossRef

10.

Milstein DM, te Boome LC, Cheung YW, Lindeboom JA, van den Akker HP, Biemond BJ, Ince C (2010) Use of sidestream dark-field (SDF) imaging for assessing the effects of high-dose melphalan and autologous stem cell transplantation on oral mucosal microcirculation in myeloma patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:91–97PubMedCrossRef

11.

Steeghs N, Gelderblom H, Roodt JO, Christensen O, Rajagopalan P, Hovens M, Putter H, Rabelink TJ, de Koning E (2008) Hypertension and rarefaction during treatment with telatinib, a small molecule angiogenesis inhibitor. Clin Cancer Res 14:3470–3476PubMedCrossRef

12.

Top AP, Ince C, van Dijk M, Tibboel D (2009) Changes in buccal microcirculation following extracorporeal membrane oxygenation in term neonates with severe respiratory failure. Crit Care Med 37:1121–1124PubMedCrossRef

13.

Top AP, Ince C, Schouwenberg PH, Tibboel D (2011) Inhaled nitric oxide improves systemic microcirculation in infants with hypoxemic respiratory failure. Pediatr Crit Care Med 12:e271–e274PubMedCrossRef

14.

Top AP, Ince C, de Meij N, van Dijk M, Tibboel D (2011) Persistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care. Crit Care Med 39:8–13PubMedCrossRef

15.

Genzel-Boroviczény O, Christ F, Glas V (2004) Blood transfusion increases functional capillary density in the skin of anemic preterm infants. Pediatr Res 56:751–755PubMedCrossRef

16.

Weidlich K, Kroth J, Nussbaum C, Hiedl S, Bauer A, Christ F, Genzel-Boroviczeny O (2009) Changes in microcirculation as early markers for infection in preterm infants: an observational prospective study. Pediatr Res 66:461–465PubMedCrossRef

17.

Hiedl S, Schwepcke A, Weber F, Genzel-Boroviczeny O (2010) Microcirculation in preterm infants: profound effects of patent ducts arteriosis. J Pediatr 156:191–196PubMedCrossRef

18.

Blumhagen JD, Maclin L, Krauter D, Rosenbaum DM, Weinberger E (1988) Sonographic diagnosis of hypertrophic pyloric stenosis. AJR Am J Roentgenol 150:1367–1370PubMedCrossRef

19.

Najmaldin A, Tan HL (1995) Early experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. J Pediatr Surg 30:37–38PubMedCrossRef

20.

Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C (2007) Sidestream dark-field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express 15:15101–15114PubMedCrossRef

21.

Milstein DMJ, Bezemer R, Ince C (2012) Sidestream dark-field (SDF) video microscopy for clinical imaging of the microcirculation. In: Leahy MJ (ed) Microcirculation imaging. Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim, pp 37–52CrossRef

22.

De Backer D, Hollenberg S, Boerma C, Goedhart P, Büchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101PubMedCrossRef

23.

Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF (2002) Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 360:1395–1396PubMedCrossRef

24.

Boerma EC, Mathura KR, van der Voort PH, Spronk PE, Ince C (2005) Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care 9:R601–R606PubMedCrossRef

25.

Jia WQ, Tian JH, Yang KH, Ma B, Liu YL, Zhang P, Li RJ, Jia RH (2011) Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials. Eur J Pediatr Surg 21:77–81PubMedCrossRef

26.

Hall NJ, Pacilli M, Eaton S, Reblock K, Gaines BA, Pastor A, Langer JC, Koivusalo AI, Pakarinen MP, Stroedter L, Beyerlein S, Haddad M, Clarke S, Ford H, Pierro A (2009) Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 373:390–398PubMedCrossRef

27.

Laing S, Walker K, Ungerer J, Badawi N, Spence K (2011) Early development of children with major birth defects requiring newborn surgery. J Paediatr Child Health 47:140–147PubMedCrossRef

28.

Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, Büchler MW (2004) Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 21:95–105PubMedCrossRef

29.

Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, Gravenstein JS (1978) Cardiac function and hypercarbia. Arch Surg 113:1196–1200PubMedCrossRef

30.

Simmons GH, Minson CT, Cracowski JL, Halliwill JR (2007) Systemic hypoxia causes cutaneous vasodilation in healthy humans. J Appl Physiol 103:608–615PubMedCrossRef

31.

Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG (1999) Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 5:1209–1212PubMedCrossRef

Title: Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy
Authors: Stefaan H. A. J. Tytgat
David C. van der Zee
Can Ince
Dan M. J. Milstein
Publication date: 01-09-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2927-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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