Shalvi Mahajan1, Rajeev Chauhan2*, Ankur Luthra2, Indu Bala3 and Neerja Bharti2
1Department of Anaesthesia, Fortis Hospital Mohali, India
2Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, India
3Department of Anaesthesia, Post Graduate Institute of Medical Education & Research, India
Background: End Tidal Carbon Dioxide (EtCO2 ) is a noninvasive and reliable measurement of Arterial Carbon Dioxide (PaCO2 ). However gradient between PaCO2 and ETCO2 [P(a-Et)CO2 ] is influenced by many factors. In the present study we evaluated the changes in P(a-Et)CO2 in patients undergoing laparoscopic donor nephrectomy in Lateral Decubitus Position (LDP).
Methods: Thirty one ASA I and II patients of either sex undergoing laparoscopic donor nephrectomy in LDP under general anesthesia were included. An arterial cannula was inserted and PaCO2 was measured at eight pre designated time intervals. Hemodynamic parameters, temperature, oxygen saturation all were recorded simultaneously.
Results: The mean P(a-Et)CO2 gradient was 5.67 ± 1.36 mmHg 10 mins after induction of anesthesia in supine position (T1a). Ten minutes after LDP P(a-Et)CO2 gradient was 7.38 ± 1.45 mmHg (T1b) and this was significantly higher than T1a. After creation of pneumoperitoneum P(a-Et)CO2 values at 30, 60, 120 mins were significantly higher than the supine and LDP values. The P(a-Et)CO2 value 10 mins after release of pneumoperitoneum and 10 mins after making the patient supine were significantly higher than the T1a value. The highest value of P(a-Et)CO2 gradient was at 30 mins after creation of pneumoperitoneum (T30) i.e., 9.99 ± 1.70 mmHg. Pearson correlation coefficient showed that the degree of correlation varied considerably during surgery due to inter individual variability (R2 T1a vs. T60 was 0.61 vs 0.17). Throughout intraoperative period hemodynamic parameters and temperature were stable.
Conclusion: EtCO2 does not reliably predict PaCO2 in healthy patients scheduled for laparoscopic renal surgery in lateral decubitus position.
Carbon dioxide; Pneumoperitoneum; Partial pressure; Laproscopic surgery
Mahajan S, Chauhan R, Luthra A, Bala I, Bharti N. Evaluation of Arterial to End-Tidal CO2 [P(A-Et)CO2 ] Pressure Differences in Patients Undergoing Laparoscopic Renal Surgery in the Lateral Decubitus Position. Ann Clin Anesth Res. 2019; 3(2): 1022.