Arterial to End-Tidal Carbon Dioxide Difference During Pediatric Laparoscopic Surgeries

Study Overview
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Brief Summary
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Studying the arterial to end-tidal carbon dioxide difference in children undergoing laparoscopic surgeries under different intra-abdominal pressures is of extreme importance. This is because both hyper and hypocarbia are detrimental in this vulnerable age group.

Detailed Description
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Capnography provides a non-invasive estimate of arterial CO2 levels and allows clinicians to modify mechanical ventilation settings in order to maintain normocapnia. Normally, a positive gap between arterial CO2 and ETCO2 of approximately 0.5 kPa is assumed in a healthy patient and ventilation settings are adjusted accordingly. However, the correlation between PaCO2 and PetCO2 during laparoscopic surgery is inconsistent mainly due to inter- and intra-individual variability. Discrepancies between arterial carbon dioxide and End-tidal carbon dioxide measures have been demonstrated in ventilated children with cyanotic congenital heart disease , infants with respiratory failure and during visceral and urological laparoscopic surgery. Moreover, as the increase in PaCO2 is directly proportional to the level of intra-abdominal pressure (IAP) used, variations in the arterial to end-tidal carbon dioxide difference can be also expected with different levels of IAP used.

Official Title
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Arterial to End-Tidal Carbon Dioxide Difference During Pediatric Laparoscopic Surgeries

Conditions
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Intraoperative Ventilation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children with the following inclusion criteria; Weight: 10-30 kg. Age: 1-6 years. Sex: both males and females. ASA physical status: I, II. Operation: elective laparoscopic surgeries that last more than 45 min. Exclusion Criteria: Patients will be excluded if they have; Patients with any perioperative cardiovascular or respiratory event occurred which made the study intervention clinically unacceptable, Patients with unsatisfactory preoperative peripheral arterial oxygen saturation, Patients with unsatisfactory preoperative hemoglobin level, neurological or psychiatric disease, Children with a BMI >95th percentile for age.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 6 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| One sample<br>Laparoscopic surgeries will be performed according to the standard surgical and anesthesia protocols. Pneumo-peritoneum will be achieved using non-heated non-humidified CO2 with the intra-abdominal pressure (IAP) maintained at 10-12mmHg | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between the Arterial to end-tidal carbon dioxide | The arterial CO2 will be analysed from the blood gas and the endtidal carbon dioxide will be recorded from the capnography tracing. | Intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PaCO2-ETCO2 Difference | The arterial CO2 will be analysed from the blood gas and the endtidal carbon dioxide will be recorded from capnography. | Intraoperative | 
| Heart rate | The heart rate will be continuously monitored, intraoperatively | Intraoperative | 
| The noninvasive systolic and diastolic arterial blood pressure | The non invasive systolic and diastolic arterial blood pressure will be recorded at fixed intervals | intraoperative |