Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking.

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_ETCO₂) 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_ETCO₂ and peak airway pressure (PAP) at 5 min before (control value) and after CO₂ insufflation and 5 min after CO₂ deflation.

SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P < 0.05). P_ETCO₂ 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).

SAP, PAP and P_ETCO₂ 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.