Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques

Abstract

Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling.

Could cough be an intraoperative indicator for venous air embolism in deep brain stimulation surgeries?: experiences from a large case series

“…The diagnosis of VAE in the operating room is generally based on clinical experiences, and invasive methods are not suitable because they cannot be utilized with conscious patients. ETCO 2 might be effective, however, ETCO 2 monitoring using a nasal cannula is less accurate and technically unstable [33,34]. A severe cough or a combination of a cough plus other complaints is likely to indicate the presence of VAE, and such symptoms have been used as VAE criteria in other published studies [17,19,26].…”

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“…Although it remains a standard of care for intraoperative monitoring during general anesthesia, end-tidal carbon dioxide (ETCO2) monitoring may be inaccurate during insufflation and alternative continuous techniques such as transcutaneous CO2 monitoring may offer specific advantages for continuous CO2 monitoring. 15 The impact of insufflation on hemodynamic function generally includes a decrease in preload and an increase in afterload. In the adult population, these are manifested by an increase in mean arterial pressure, systemic vascular resistance, left ventricular afterload with a concomitant decrease in cardiac index, stroke volume index, and fractional area shortening with an IAP set at 15 mmHg.…”

“…Although it remains a standard of care for intraoperative monitoring during general anesthesia, end-tidal carbon dioxide (ETCO2) monitoring may be inaccurate during insufflation and alternative continuous techniques such as transcutaneous CO2 monitoring may offer specific advantages for continuous CO2 monitoring. 15 …”

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“…The CO2 is a highly diffusible gas easily soluble in water. The CO2 is rapidly excreted through the lungs therefore; it widely applied for laparoscopic surgery in order to create manipulating space in the abdominal cavity [77]. Potential side effects of excessive CO2 insufflation are prevented by means of pressureor/and volume-controlled ventilation during laparoscopy.…”