title: Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors: Department of Anesthesiology, Shriners Hospitals for Children, Salt Lake City, UT 84103-4399, USA. jcsanders@shrinenet.org
authors: John C
authors: JC
authors: Sanders
authors: Neal
authors: N
authors: Gerstein
mesh_terms: D000367:Age Factors; D002245:Carbon Dioxide / Q000032:analysis* / Q000378:metabolism / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D006801:Humans; D006935:Hypercapnia / Q000209:etiology*; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010313:Partial Pressure; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D013990:Tidal Volume; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide