Continuous transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

Abstract

Background: Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring. We investigated the feasibility and accuracy of additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO 2 ) measurement during conscious sedation in complex electrophysiological catheter ablation procedures. Method: We evaluated the accuracy and additional value of continuous tpCO 2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses. Results: We included 110 patients in this prospective observational study. Arterial pCO 2 (paCO 2 ) and tpCO 2 showed good correlation throughout the procedures (r = 0.60-0.87, p < 0.005). Venous pCO 2 (pvCO 2 ) were also well correlated to transcutaneous values (r = 0.65-0.85, p < 0.0001). Analyses of the difference of pvCO 2 and tpCO 2 measurements showed a tolerance within <10 mmHg in up to 96-98% of patients. Hypercapnia (pCO 2 < 70 mmHg) was detected more likely and earlier by continuous tpCO 2 monitoring compared to halfhourly pvCO 2 measurements. Conclusion: Continuous tpCO 2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety.

Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques

“…Several clinical studies have focused on the application of PtcCO 2 monitoring in different types of surgery and patients [ 13 – 17 ] under non-tracheal intubation monitoring anesthesia [ 18 , 19 ]. These studies confirmed the effectiveness of PtcCO 2 monitoring.…”

“…In this situation, PtcCO 2 monitoring is a good choice. It has been shown [ 18 , 19 , 28 ] that PtcCO 2 monitoring is an effective way to detect hypoventilation in patients, which reduces the incidence, extent, and duration of hypercapnia, improving the safety of patients under sedation. High-frequency ventilation is often used to maintain oxygenation in some airway procedures performed with a rigid bronchoscope.…”

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

“…If it is technically not possible to measure reliably ExCO 2 , for example using high flow nasal oxygen, peri-procedural transcutaneous carbon dioxide level (TcCO 2 ) is an noninvasive option to monitor CO 2 [ 19 ]. TcCO 2 measurement is an alternative used during PSA as a replacement for laboratory measurement of blood CO 2 levels [ 19 , 20 ▪ ]. However invasive arterial blood pressure monitoring can be indicated in selected cases.…”