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Poor performance of main-stream capnography in newborn infants during general anesthesia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Hosp, Unit Pediat Anesthesia, Uppsala, Sweden.;Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..ORCID iD: 0000-0003-0407-2143
Univ Hosp, Unit Pediat Anesthesia, Uppsala, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research. Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research. Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
2017 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 12, p. 1235-1240Article in journal (Refereed) Published
Abstract [en]

Background

Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.

Aims

The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.

Methods

Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.

Results

Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.

Conclusion

Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

Place, publisher, year, edition, pages
2017. Vol. 27, no 12, p. 1235-1240
Keywords [en]
capnography, infant, mechanical ventilation, neonatal, perioperative, surgery
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-341986DOI: 10.1111/pan.13266ISI: 000414571000009PubMedID: 29072363OAI: oai:DiVA.org:uu-341986DiVA, id: diva2:1183754
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-06-27
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Karlsson, VictoriaHellström-Westas, LenaÅgren, Johan

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Anaesthesiology and Intensive CareDepartment of Women's and Children's HealthPerinatal, Neonatal and Pediatric Cardiology Research
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Pediatric Anaesthesia
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