Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques

Abstract

Abstract Purpose The present study aimed to investigate the correlation between transcutaneous carbon dioxide partial pressure (PtcCO 2 ) and arterial carbon dioxide pressure (PaCO 2 ) and the accuracy of PtcCO 2 in predicting PaCO 2 during laparoscopic surgery in pediatric patients. Methods Children aged 2–8 years with American Society of Anesthesiologists (ASA) class I or II who underwent laparoscopic surgery under general anesthesia were selected. After anesthesia induction and tracheal intubation, PtcCO 2 was monitored, and radial arterial catheterization was performed for continuous pressure measurement. PaCO 2 , PtcCO 2 , and end-tidal carbon dioxide partial pressure (PetCO 2 ) were measured before pneumoperitoneum, and 30, 60, and 90 min after pneumoperitoneum, respectively. The correlation and agreement between PtcCO 2 and PaCO 2 , PetCO 2 , and PaCO 2 were evaluated. Results A total of 32 patients were eventually enrolled in this study, resulting in 128 datasets. The linear regression equations were: PtcCO 2 = 7.89 + 0.82 × PaCO 2 ( r 2 = 0.70, P < 0.01); PetCO 2 = 9.87 + 0.64 × PaCO 2 ( r 2 = 0.69, P < 0.01). The 95% limits of agreement (LOA) of PtcCO 2 – PaCO 2 average was 0.66 ± 4.92 mmHg, and the 95% LOA of PetCO 2 – PaCO 2 average was –4.4 ± 4.86 mmHg. A difference of ≤ 5 mmHg was noted between PtcCO 2 and PaCO 2 in 122/128 samples and between PetCO 2 and PaCO 2 in 81/128 samples ( P < 0.01). Conclusion In pediatric laparoscopic surgery, a close correlation was established between PtcCO 2 and PaCO 2 . Compared to PetCO 2 , PtcCO 2 can estimate PaCO 2 accurately and could be used as an auxiliary monitoring indicator to optimize anesthesia management for laparoscopic surgery in children; however, it is not a substitute for PetCO 2 . Registration number of Chinese Clinical Trial Registry ChiCTR2100043636.

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