Prolonged carbon dioxide insufflation under general anesthesia for endoscopic submucosal dissection.

Area of Science:

• Gastroenterology
• Anesthesiology
• Pulmonology

Background:

• Carbon dioxide (CO2) insufflation in endoscopy aids recovery and reduces complication risks.
• General anesthesia offers benefits over intravenous sedation for endoscopic procedures.
• The impact of prolonged CO2 insufflation on arterial CO2 tension (PaCO2) during gastrointestinal endoscopy is not well understood.

Purpose of the Study:

• To evaluate the effect of prolonged CO2 insufflation on PaCO2 during esophagogastroduodenal endoscopic submucosal dissection (ESD) under general anesthesia.
• To assess the safety and feasibility of using general anesthesia with CO2 insufflation for ESD.

Main Methods:

• A prospective observational study involving 100 patients undergoing esophagogastroduodenal ESD under general anesthesia with CO2 insufflation.
• Standardized anesthesia techniques and ventilatory settings were used.
• Arterial blood gas analyses were performed at regular intervals to monitor PaCO2 levels.

Main Results:

• PaCO2 increased from a median baseline of 28 mmHg to a median peak of 39 mmHg (P < 0.001).
• Significant inter-individual variability in PaCO2 changes was observed.
• Procedure time showed a low correlation with PaCO2 levels (r=0.194).
• Factors like reduced forced expiratory volume in 1 second/forced vital capacity ratio and the type of endoscopy (esophagoscopy vs. gastroduodenoscopy) influenced PaCO2 levels.

Conclusions:

• Increases in PaCO2 during esophagogastroduodenal ESD under general anesthesia with CO2 insufflation are manageable and controllable.
• Procedure duration has minimal impact on PaCO2 elevations.
• Esophagogastroduodenal ESD can be safely and effectively performed using this technique.