Carbon dioxide elimination in anaesthetized children

Carbon dioxide elimination (VCO2) was measured in 186 anaesthetized, spontaneously breathing infants and children with body weights ranging from 2.8 to 26.5 kg. They all underwent minor paediatric surgical procedures. The influence on VCO2 of age, operation, premedication, caudal anaesthesia, and different volatile anaesthetic agents was investigated. The volume of exhaled gas, during three- to five-minute collection periods, was measured and the fraction of exhaled CO2 was determined by a CO2 meter. Under basal anaesthetic conditions, the average output before operation followed the equation: VCO2 (ml.min-1) = -1.25X + 13.0X2, in which X = lne (body weight, kg). Expressed on a weight basis, the youngest infants (weighing less than 5 kg) had the lowest VCO2. Higher values were measured up to a body weight of 10 kg above which a negative correlation occurred between VCO2 (ml.min-1.kg-1) and body weight. The use of premedication resulted in a more variable VCO2 during operations than when opioid premedication was not used. The combination of a general anaesthetic and caudal anaesthesia stabilized VCO2. Also, children anaesthetized with halothane had a higher VCO2 than those who were anaesthetized with enflurane or isoflurane (P less than 0.05). The variable VCO2 emphasizes the need for increased monitoring of VCO2 during routine anaesthesia and operation in infants and children.