Abstract
Expired carbon dioxide measurements (PECO2) were used (1) to assess the adequacy of initial alveolar ventilation, and (2) to document intraoperative airway events and metabolic trends. Three hundred and thirty-one children were studied. Thirty-five intraoperative events were diagnosed by continuous PeCO2 monitoring; 20 were potentially life-threatening problems (malignant hyperthermia, circuit disconnection or leak, equipment failure, accidental extubation, endobronchial intubation, or kinked tube); only two of these were also diagnosed clinically. The duration of anaesthesia may be a factor: 3.9 hours for cases with events vs. 2.5 hours for cases without events (p < 0.002). There was a higher incidence of hypercarbia (peak expired PeCO2≥ 50) in children who were not intubated (29 per cent) compared to those who had an endotracheal tube in place (12 per cent) (p = 0.0001). Hypocarbia (peak expired PeCO2≤30) was more frequent in intubated cases (11 per cent) than in unintubated cases (three per cent) (p = 0.03). There was a high incidence of hypocarbia in infants less than one year of age (p = 0.02). We conclude: (1) lifethreatening airway problems are common during anaesthesia in paediatric patients; (2) quantitative measurement of PECO2 provides an early warning of potentially catastrophic anaesthetic mishaps; (3) the incidence of events increases with duration of anaesthesia.
Résumé
L’6tude du CO2 en fin dexpiration (PeCO2) a été utilisée afin d’évaluer (1) la fonction respiratoire initiate et (2) pour documenter les événemenls per-opératoires touchant les voies aériennes ainsi que les changements métaboliques. 331 enfants ont été étudiés. 35 événements per-opératoires ont été diagnostiqués par une surveillance constante de la PeCO2; 20 représentaient des problèmes mettant en danger la vie (hyperthermie maligne, disconnection de circuit, fuite, bris d’équipement, extubation accidentelle, intubation endobronchique, ou tube endotrachéal coudd); seulement deux de ces événements ont été aussi diagnostiqués cliniquement. La durée de l’anesthésie pouvait aussi être un facteur: les présentants les accidents ont duré en moyenne 3.9 heurs contre 2.5 heures pour les cas n’ayant pas présenté de problèmes (p < 0.002). Il y avait un incidence plus élevée d’hypercarbie (PECO2 ≥ 50,) chez les enfants qui n’étaient pas intubés (29 pour cent) a comparé à ceux dont le tube endotrachéal élail en place (12 pour cent) (p = 0.0001). L’hypocarbie (PeCO2 ≤ 30) était plus fréquente chez les patients intubés (11 pour cent) que chez ceux qui n’étaient pas intubés (trois pour cent) (p = 0.03). It y avait une incidence plus grande d’hypocarbie chez les enfants âgés de moins qu’un an (p = 0.02). On colclut: 1) les problemes de voies aeriennes pouvant mettre en danger la vie sont fréquents lors de I’anesthésie pédiatrique; 2) la mesure quantitative de la PeCO2 fournie un signal d’alarme précoce pour les accidents anesthésiques potentiellement catastrophiques; 3) l’incidence des accidents augmente avec le temps.
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Supported by an equipment grant from Datex, Inc., distributed through Puritan-Bennet Corporation, Langhorne, Pennsylvania.
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Coté, C.J., Liu, L.M.P., Szyfelbein, S.K. et al. Intraoperative events diagnosed by expired carbon dioxide monitoring in children. Can Anaesth Soc J 33, 315–320 (1986). https://doi.org/10.1007/BF03010743
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DOI: https://doi.org/10.1007/BF03010743