The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.
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And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD).The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89).The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD).
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Affiliation: Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
ABSTRACT
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To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. Related in: MedlinePlus |
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Mentions: 21 patients (8 men and 13 women; age from 19–55 yr, 29(9)yr; weight from 86 to 160 kg, 119.3(22.1)kg; BMI from 35.3 to 51.1 kg/m2, 42.1(5.4) kg/m2) were recruited into this study. All patients underwent laparoscopic bariatric surgery. The PaCO2, PetCO2, and PTCCO2 values were recorded at 4 time points. Eight-four samples were finally obtained. The mean values of these variables at different time points are presented in Table 1 and Figure 1. In these samples, PTCCO2 was correlated with PaCO2 at each time point (r = 0.90, 0.89, 0.93 and 0.90, respectively, P<0.01). PetCO2 was correlated with PaCO2 at each time point (r = 0.66, 0.71, 0.69 and 0.86, respectively, P<0.01). The PaCO2 values were ranging from 42.2 to 58.4 mmHg. The average PaCO2–PetCO2 difference was 10.3±2.3 mmHg and the average PaCO2–PTCCO2 difference was 0.9±1.3 mmHg. In those samples, both PetCO2 and PTCCO2 were closely correlated with PaCO2. The linear regression equation between PetCO2 and PaCO2 was PetCO2 = 11.58+0.57×PaCO2, r2 = 0.64, P<0.01(Figure 2); and PTCCO2 and PaCO2 was PTCCO2 = 0.60+0.97×PaCO2, r2 = 0.89, P<0.01(Figure 3). In all samples, there wasn’t a difference of 3 mmHg or less between PaCO2 and PetCO2, yet there was a difference of 3 mmHg or less between PaCO2 and PTCCO2 in 79 of the 84 samples (P<0.01). Only one PetCO2–PaCO2 difference (absolute value) was 5 mmHg or less while all values of PTCCO2–PaCO2 difference (absolute value) were 5 mmHg or less (P<0.01). According to Bland-Altman analysis, the 95% limits of agreement (LOA) of the average PaCO2–PetCO2 difference was 10.3±4.6 mmHg (mean±1.96 SD, Figure 4), while the 95% limits of agreement (LOA) of the average PaCO2–PTCCO2 difference was 0.9±2.6 mmHg (mean±1.96 SD, Figure 5). |
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Affiliation: Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.