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We examined cardiovascular changes associated with intra‐abdominal insufflation in 20 children (mean age 6.1 ± 4.7 years, ASA physical status I or II) undergoing laparoscopic surgery with general anaesthesia using echocardiography with a transthoracic approach. Intra‐abdominal pressure never exceeded 10 mmHg. Systolic blood pressure, diastolic blood pressure, endtidal CO₂, peak, and mean airway pressure increased during intra‐abdominal insufflation (P < 0.001). Pneumoperitoneum was associated with increases (P < 0.001) in left ventricular enddiastolic volume, left ventricular end‐systolic volume and left ventricular endsystolic meridional wall stress. In addition, before, during and after intra‐abdominal insufflation, left ventricular fractional shortening and left ventricular ejection fraction, underwent slight, insignificant changes. Pneumoperitoneum in children has a major impact on cardiac …