Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication.
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.
Sanders
John C
JC
Department of Anesthesiology, Shriners Hospitals for Children, Salt Lake City, UT 84103-4399, USA. jcsanders@shrinenet.org
Gerstein
Neal
N
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
D002245:Carbon Dioxide