Difference between arterial and end-tidal carbon dioxide pressures during laparoscopy in paediatric patients

Abstract

Purpose: To assess the effect of pneumoperitoneum on P(a-ET)CO2 gradient in children.

Methods: Sixty one ASA I and II children (10.7 +/- 3.0 yr, 38.4 +/- 14.2 kg, mean +/- SD), scheduled for visceral or urological laparoscopic procedures, were studied. They were anaesthetized, intubated, paralysed and their lungs ventilated with constant ventilator settings to obtain PETCO2 values between 4.3 and 4.8 kPa. Intra-abdominal pressure was maintained between 8 and 14 mmHg. The following measurements were performed at steady state, before the pneumoperitoneum (T1) and 15 min later (T2): heart rate, systolic and diastolic arterial pressure; peak airway and intra-abdominal pressure; PaCO2 corrected for the patient's temperature; PETCO2 drawn between the micropore filter and the ventilator tubes, corrected for BTPS conditions; P(a-ET)CO2. Values between -1.0 and +1.0 mmHg were considered nil; patient position (horizontal or head-down tilt): all patients were horizontal at T1.

Results: Arterial pressure, heart rate and peak airway pressure increased at T2: PaCO2 and PETCO2 increased by 14%. The incidence of negative gradients increased from 54 to 67% although mean P(a-ET)CO2 remained clinically unchanged. No difference was found in P(a-ET)CO2 gradient, whatever the position and intra-abdominal pressure. The 95% confidence intervals for P(a-ET)CO2 were [-5.6; +3.2] at T1 and [-8.8; +4.8] at T2.

Conclusion: PETCO2 often overestimates PaCO2 during laparoscopy in children, by up to 8.8 mmHg. Arterial blood gas analysis should be performed during long procedures to avoid hyperventilation.