Author(s)

Zvi C. Jacob^1*, Roger Fan², Ruth A. Reinsel¹, Nehul Patel¹, Arvind Chandrakantan^1,3

¹Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA.
²Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA.
³Current Address: Department of Anesthesiology, Texas Children’s Hospital, Houston, TX, USA.

Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO₂) monitoring during jet ventilation for cardiac ablation. The use of tcPCO₂ during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO₂ measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO₂ levels allows evaluation of the accuracy of the tcPCO₂ technique for use during jet ventilation. Design: Observational study; patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO₂ (EtCO₂) and transcutaneous CO₂ (tcPCO₂) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO₂ (PaCO₂) levels and tcPCO₂ were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO₂ values consistently provided a close approximation to PaCO₂ levels. The mean difference between tcPCO₂ and EtCO₂ values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO₂ provides an acceptable estimate of CO₂ concentration in arterial blood during JV, as well as prior to and following JV.

High Frequency Jet Ventilation, Cardiac Ablation, Transcutaneous CO₂ Monitoring, End-Tidal CO₂ Monitoring, General Anesthesia

Jacob, Z. , Fan, R. , Reinsel, R. , Patel, N. and Chandrakantan, A. (2017) Preliminary Validation of Transcutaneous CO₂ Monitoring in Patients Undergoing Cardiac Ablation Using Jet Ventilation. Open Journal of Anesthesiology, 7, 315-327. doi: 10.4236/ojanes.2017.79031.