Laparoscopic colon surgery: unreliability of end-tidal CO2 monitoring

Background: The relatively good haemodynamic and respiratory tolerance to abdominal CO2 insufflation has mostly been observed in healthy patients during short‐lasting laparoscopic procedures. End‐tidal CO2 pressure (PetCO2) has been shown to be a reliable method to assess arterial CO2 (PaCO2) in the absence of cardio‐respiratory disease in this setting. However, no study has investigated whether PetCO2 is accurately related to PaCO2 during laparoscopic colon surgery. Indeed, these procedures last longer, prolonging the pneumoperitoneum and requiring a Trendelenburg position. The aim of the present study was to measure the PaCO2–PetCO2 difference over time in patients undergoing laparoscopic colon surgery and to determine whether PaCO2 is reliably assessed by PetCO2. Methods: Forty consecutive patients (ASA I and II) scheduled for laparoscopic colon surgery were anaesthetized and ventilated to obtain a PetCO2 between 4.0 and 5.5 kPa. After initiation of CO2 insufflation, PaCO2 and PetCO2 were recorded every 30 min during surgery. Results: No complication was observed during anaesthesia. The mean arterial pressure increased significantly after CO2 insufflation and remained steady up to the end of pneumoperitoneum. The heart rate remained stable over time. The relation between PaCO2 and PetCO2 was not constant among patients and increased over time within the same patients. The R2 values fluctuated and did not show a constant correlation between PaCO2 and PetCO2. Conclusion: The correlation between PaCO2 and PetCO2 during laparoscopic colon surgery is inconsistent mainly due to inter‐ and intra‐individual variability.