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Published on: April 17, 2020
Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication
John C Sanders1, Neal Gerstein
1Department of Anesthesiology, Shriners Hospitals for Children, Salt Lake City, UT 84103-4399, USA. jcsanders@shrinenet.org
Background:
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.
Objectives:
Our objective was to assess the extent of the P(a)CO(2) to ETCO(2) gradient in children during laparoscopic fundoplication.
Methods:
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.
Results:
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).
Conclusions:
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 blood gas measurement in some patients.
