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Transcutaneous PCO2 monitoring during laparoscopic cholecystectomy in pregnancy

Canadian Journal of Anaesthesia volume 45, Article number: 164 (1998) Cite this article

Abstract

Purpose

Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring (PtcCO2) as an approach to optimise ventilation during laparoscopic surgery in pregnancy.

Method

A healthy parturient received general anaesthesia for laparoscopic cholecystectomy. Pulmonary ventilation was adjusted to maintain end-tidal carbon dioxide (conventional PETCO2) at 32 mmHg during CO2 insufflation. A PtcCO2 monitor was used to trend PaCO2 throughout the procedure. Mechanical ventilation was interrupted every five minutes to obtain an end-tidal PCO2 value at large tidal volume (squeeze PETCO2).

Results

The PtcCO2 increased from 39 mmHg before induction to 45 mmHg after CO2 insufflation. This corresponds to an estimated maximum PaCO2 of 39–40 mmHg during insufflation. The PtcCO2 gradually returned to pre-induction baseline values one hour after the termination of CO3 insufflation. Squeeze PETCO2 values approximated PtcCO2 more closely than did conventional PETCO2 values (P < 0.01).

Conclusion

Continuous PtcCO2 measurements as well as squeeze PetCO2 may be of clinical value in trending and preventing hypercarbia during laparoscopic surgery.

Résumé

Objectif

L’acidose respiratoire durant l’insufflation au CO2 a été proposée comme cause d’avortement spontané et de travail prématuré à la suite de cholécystectomie laparoscopique durant la grossesse. La capnométrie peut ne pas être un guide adéquat pour ajuster la ventilation durant la chirurgie laparoscopique et de ce fait le monitoring du CO2 artériel a été recommandé. Cette étude rapporte la faisabilité et les bénéfices du monitorage du CO2 par voie transcutanée (PtcCO2) comme mesure d’optimalisation de la ventilation durant la chirurgie laparoscopique pendant la grossesse.

Méthode

Une parturiente en bonne santé a subi une cholécystectomie par laparoscopie sous anesthésie générale. La PCO2 en fin d’expiration (PETCO2 conventionnelle) a été maintenue à 32 mmHg durant l’insufflation de CO2 en ajustant la ventilation pulmonaire. Un moniteur de PCO2 transcutanée a été utilisé pour établir la tendance durant la procédure. A toutes les cinq minutes, la ventilation mécanique était interrompue pour mesurer la PCO2 de fin d’expiration suite à un volume courant élevé (“Squeeze” PETCO2).

Résultats

La PtcCO2 était de 39 mmHg avant l’induction et a augmenté à 45 mmHg après l’insufflation avec le CO2. Ceci correspond à une PaCO2 maximale estimée de 39–40 mmHg durant l’insufflation. La PtcCO2 a retrouvé progressivement les valeurs de base une heure après la fin de l’insufflation de CO2. La PETCO2 suite à un volume courant élevé a une meilleure corrélation avec la PtcCO2 que la PETCO2 normale (P < 0,01 ).

Conclusion

Les mesures de la PtcCO2 de même que celles de la PETCO2 suite à un volume courant élevé peuvent être cliniquement utiles durant la chirurgie laparoscopique pour établir la tendance et prévenir l’hypercarbie.

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Affiliations

  1. Department of Anaesthesia, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, 02115, Boston, MA, USA

    K. Bhavani-Shankar, R. A. Steinbrook, P. S. Mushlin & D. Freiberger

Authors
  1. K. Bhavani-Shankar
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  2. R. A. Steinbrook
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  3. P. S. Mushlin
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  4. D. Freiberger
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Bhavani-Shankar, K., Steinbrook, R.A., Mushlin, P.S. et al. Transcutaneous PCO2 monitoring during laparoscopic cholecystectomy in pregnancy. Can J Anaesth 45, 164 (1998). https://doi.org/10.1007/BF03013257

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  • DOI: https://doi.org/10.1007/BF03013257

Keywords

  • Laparoscopic Cholecystectomy
  • Preterm Labour
  • Foetal Heart Rate
  • Respiratory Acidosis
  • Pulmonary Ventilation