Transcutaneous carbon dioxide monitoring in children undergoing rigid bronchoscopy: a prospective blinded observational study.

PURPOSE

Anesthetic management during rigid bronchoscopy in children can be challenging, and continuous end-tidal carbon dioxide (EtCO) monitoring is often unachievable. Transcutaneous carbon dioxide (TcCO) monitoring is strongly correlated with the partial pressure of carbon dioxide (PaCO) and EtCO. We aimed to investigate the incidence of hypercapnia in children undergoing rigid bronchoscopy.

METHODS

We enrolled patients aged < 18 yr scheduled for rigid bronchoscopy in a prospective observational study. We recorded TcCO values from anesthesia induction to the postanesthesia care unit (PACU) stay. We ended monitoring when TcCO reached values ≤ 50 mm Hg. The operating room (OR) team was blinded to the TcCO. The outcome of primary interest was the incidence of hypercapnia (TcCO > 50 mm Hg) in the OR. Other outcomes were the incidences of hypercapnia in the PACU and severe hypercapnia (TcCO > 90 mm Hg), factors possibly related to hypercapnia (patient, surgery, or anesthesia factors), and the incidence of perioperative adverse events.

RESULTS

A total of 30 patients were enrolled. The median [interquartile range (IQR)] age was 3.5 [1.5-8.0] yr. The incidence of hypercapnia was 100% in the OR and 60% in the PACU. Five cases (17%) presented with severe hypercapnia in the OR. The highest median [IQR] TcCO was 69 [61-79] mm Hg. The most common adverse event was oxygen desaturation (57%, 17/30). Patients with severe hypercapnia had long stays in the PACU.

CONCLUSION

Hypercapnia was a frequent event in children undergoing rigid bronchoscopy and severe hypercapnia was associated with a long PACU stay. Further studies are needed to assess the utility of TcCO monitoring in guiding ventilatory interventions during these cases.