CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by COTÉ, C. J.
Right arrow Articles by DANIELS, A. L.
Right arrow Search for Related Content
PubMed
Right arrow Articles by COTÉ, C. J.
Right arrow Articles by DANIELS, A. L.

Canadian Journal of Anesthesia, Vol 33, 315-320, Copyright © 1986 by Canadian Anesthesiologists' Society

Intraoperative events Diagnosed by Expired Carbon Dioxide Monitoring in Children

CHARLES J. COTÉ MD1, LETTY M. P. LIU MD1, STANISLAW K. SZYFELBEIN MD1, SUSAN FIRESTONE MD1, NISHAN G. GOUDSOUZIAN MD1, JAMES P. WELCH BSEE CCE1, and ALFRED L. DANIELS MA1

1 Anesthesia Services of the Massachusetts General Hospital and the Shriners Burns Institute, and the Department of Anesthesia, Harvard Medical School, Boston, Massachusetts

Address correspondence to: Dr. Coté Department of Anesthesia, Massachusetts General Hospital, Boston MA 02114.

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 2 ≥ 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) life-threatening 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.

Key Words: ANAESTHESIA • paediatric • AIRWAY • obstruction • CARBON DIOXIDE MEASUREMENT • tension, expired • COMPLICATIONS • accidents • INTUBATION • tracheal, endobronchial, oesophageal






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1986 by the Canadian Anesthesiologists' Society.