Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication

Paediatric Anaesthesia
John C Sanders, Neal Gerstein

Abstract

Discrepancies between arterial carbon dioxide (P(a)CO(2)) and endtidal carbon dioxide (ETCO(2)) measures have been demonstrated in ventilated children with cyanotic congenital heart disease, infants with respiratory failure and during visceral and urological laparoscopic surgery. Our objective was to assess the extent of the P(a)CO(2) to ETCO(2) gradient in children during laparoscopic fundoplication. We prospectively collected data on patient characteristics, surgical conditions, pH, ETCO(2)and P(a)CO(2) during laparoscopic fundoplication using carbon dioxide insufflation in children age <29 months. Data were collected on nine cases, four cases aged <1 year. A P(a)-ETCO(2) gradient was present during insufflation. The gradient was larger in children age less than 1 year but statistically significantly different from a value of zero, only at t = 30 min (mean = 8 mmHg, sem = 0.81, P = 0.004) and t = 60 min (mean = 5 mmHg, sem = 1, P = 0.014). Minute ventilation was increased from 20% to 100% to control ETCO(2). ETCO(2) may not accurately represent arterial values during laparoscopic fundoplication, especially in the infant when carbon dioxide insufflation is used. Consideration should be given to placing an arterial line for blo...Continue Reading

References

Oct 1, 1991·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·V A Lazzell, F A Burrows
Jul 21, 1998·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·M LaffonC Mercier
Mar 14, 2001·Anesthesiology Clinics of North America·J H Pennant
Jan 22, 2003·Paediatric Anaesthesia·E E C De Waal, C J Kalkman
Nov 18, 2003·Paediatric Anaesthesia·Alexander DullenkopfMarkus Weiss

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Citations

Mar 8, 2011·Anaesthesia and Intensive Care·P A BakerUNKNOWN Australian and New Zealand College of Anaesthetists
Jan 21, 2015·Der Anaesthesist·A TimmermannF Pühringer
Nov 6, 2015·Current Opinion in Anaesthesiology·Arnd TimmermannSebastian Giuseppe Russo

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