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Published on: September 29, 2020
Transcutaneous CO2 Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing
Debra Don1, Beth Osterbauer1, Sameh Nour2
1Division of Otolaryngology Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, U.S.A.
Objectives/Hypothesis:
Children undergoing tonsillectomy for sleep-disordered breathing are at risk for respiratory compromise when narcotics are administered. Severe complications resulting from hypoxia can include neuro-devastation and death. The objective of this prospective study was to evaluate the feasibility, accuracy, and utility of transcutaneous carbon dioxide (tcPCO2) monitoring during and after adenotonsillectomy.
Study Design:
Prospective, Observational study.
Methods:
Twenty-nine children with sleep-disordered breathing scheduled for adenotonsillectomy were included in the study. Peri-operative measurements of tcPCO2 were compared against a single venous blood sample (PaCO2) and end-tidal (ET) CO2. The differences between ETCO2, tcPCO2 measures, and PaCO2 were examined using non-paired t-tests and linear regression. Parameters from PSG were recorded and associations with tcPCO2 values were performed using linear regression analysis. Group comparisons were made between pre-, intra-, and post-operative tcPCO2 measurements.
Results:
Similar to ETCO2, there was good correlation of tcPCO2 to PaCO2. Children with lower oxygen (O2) saturation nadirs had higher peak CO2 levels during surgery and spent a greater proportion of time with CO2 > 50 mmHg in the recovery room (P < .01 and P < .08). Other PSG measures (apnea-hypopnea index, O2 desaturation index, and peak CO2) did not have any significant correlation. Frequent episodes of hypercapnia were noted intra- and post-operatively and mean tcPCO2 values during both periods were significantly higher than baseline (P < .001).
Conclusions:
tcPCO2 monitoring is viable in children undergoing adenotonsillectomy and can provide a good estimate of hypoventilation. tcPCO2 measurements may have particular benefit in the post-operative setting and may assist in identifying children at greater risk for respiratory complications.
Level Of Evidence:
4 Laryngoscope, 131:1410-1415, 2021.
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