Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques

PURPOSE: The present study aimed to investigate the correlation between transcutaneous carbon dioxide partial pressure (PtcCO(2)) and arterial carbon dioxide pressure (PaCO(2)) and the accuracy of PtcCO(2) in predicting PaCO(2) during laparoscopic surgery in pediatric patients. METHODS: Children aged 2–8 years with American Society of Anesthesiologists (ASA) class I or II who underwent laparoscopic surgery under general anesthesia were selected. After anesthesia induction and tracheal intubation, PtcCO(2) was monitored, and radial arterial catheterization was performed for continuous pressure measurement. PaCO(2), PtcCO(2), and end-tidal carbon dioxide partial pressure (PetCO(2)) were measured before pneumoperitoneum, and 30, 60, and 90 min after pneumoperitoneum, respectively. The correlation and agreement between PtcCO(2) and PaCO(2), PetCO(2), and PaCO(2) were evaluated. RESULTS: A total of 32 patients were eventually enrolled in this study, resulting in 128 datasets. The linear regression equations were: PtcCO(2) = 7.89 + 0.82 × PaCO(2) (r(2) = 0.70, P < 0.01); PetCO(2) = 9.87 + 0.64 × PaCO(2) (r(2) = 0.69, P < 0.01). The 95% limits of agreement (LOA) of PtcCO(2) – PaCO(2) average was 0.66 ± 4.92 mmHg, and the 95% LOA of PetCO(2) – PaCO(2) average was –4.4 ± 4.86 mmHg. A difference of ≤ 5 mmHg was noted between PtcCO(2) and PaCO(2) in 122/128 samples and between PetCO(2) and PaCO(2) in 81/128 samples (P < 0.01). CONCLUSION: In pediatric laparoscopic surgery, a close correlation was established between PtcCO(2) and PaCO(2). Compared to PetCO(2), PtcCO(2) can estimate PaCO(2) accurately and could be used as an auxiliary monitoring indicator to optimize anesthesia management for laparoscopic surgery in children; however, it is not a substitute for PetCO(2). REGISTRATION NUMBER OF CHINESE CLINICAL TRIAL REGISTRY: ChiCTR2100043636. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-023-03836-2.