Abdel-Ghaffar Hala Saad, Bakr Mohammed Abdel-Moneim, Osman Mohamed Abdel-Kadr, Hanna Sarah George Labib, Ali Wesam Nashat
Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt.
Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt.
Braz J Anesthesiol. 2024 Sep-Oct;74(5):744261. doi: 10.1016/j.bjane.2021.07.036. Epub 2021 Aug 16.
Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO). We analyzed the relationship between ETCO and PaCO with time in elective pediatric laparoscopic surgeries.
This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO and ETCO computed from 29 children (ASA I, 12...72 months). Arterial blood samples were withdrawn before, at 15...minutes and 30...minutes during pneumoperitoneum and 1...minute after deflation. ETCO value was recorded simultaneously, while arterial blood was withdrawn. PaCO...ETCO relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement.
Out of the 116 comparisons analyzed, a PaCO...ETCO difference beyond 0 to ..± 5...mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO and ETCO was recorded before (r...=...0.617, p...=...0.000) and at 15...minutes (r...=...0.582, p...=...0.001), with no significant correlation at 30 minutes (r...=...0.142, p...=...0.461), either after deflation (r...=...0.108, p...=...0.577). Bland-Altman plots showed agreement between ETCO and PaCO before inflation with mean PaCO-ETCO difference 0.14........5.6...mmHg (limits of 95% agreement -10.84...11.2, simple linear regression testing p-value 0.971), with no agreement at 15...minutes (0.51........7.15, -13.5...14.5, p...=...0.000), 30...minutes. (2.62........7.83, -12.73...17.97, p...=...0.000), or after deflation (1.81........6.56, -10.93...14.55, p...=...0.015).
Usage of capnography as a trend monitor in pediatric laparoscopic surgeries may not be a reliable surrogate for PaCO levels.
Clinical Trials. gov (Identifier: NCT03361657).
强烈建议在小儿腹腔镜手术麻醉期间机械通气时维持正常碳酸血症。关于使用二氧化碳描记法（ETCO）作为评估动脉血二氧化碳水平（PaCO）的趋势监测指标存在争议。我们分析了择期小儿腹腔镜手术中ETCO与PaCO随时间的关系。
本研究是一项前瞻性观察队列分析，对29名儿童（ASA I级，12……72个月）的PaCO和ETCO进行了116对比较。在气腹前、气腹期间15……分钟和30……分钟以及放气后1……分钟采集动脉血样本。采集动脉血时同时记录ETCO值。通过Pearson相关系数和Bland Altman一致性方法评估PaCO……ETCO关系。
在分析的116对比较中，71对（61.2%）记录到PaCO……ETCO差值超过0至..±5……mmHg，其中34对（29.3%）为负差值。在气腹前（r...=...0.617，p...=...0.000）和气腹15……分钟时（r...=...0.582，p...=...0.001）记录到PaCO与ETCO之间存在显著正相关，气腹30分钟时（r...=...0.142，p...=...0.461）以及放气后（r...=...0.108，p...=...0.577）无显著相关性。Bland-Altman图显示气腹前ETCO与PaCO一致，平均PaCO - ETCO差值为0.14........5.6...mmHg（95%一致性界限为 - 10.84...11.2，简单线性回归检验p值为0.971），气腹15……分钟时不一致（0.51........7.15， - 13.5...14.5，p...=...0.000），气腹30……分钟时（2.62........7.83， - 12.73...17.97，p...=...0.000）以及放气后（1.81........6.56， - 10.93...14.55，p...=...0.015）也不一致。
在小儿腹腔镜手术中使用二氧化碳描记法作为趋势监测指标可能不是PaCO水平的可靠替代指标。
ClinicalTrials.gov（标识符：NCT03361657）
