Changes in Arterial to End Tidal CO2Difference during Repairing Heart Surgery: Cyanotic Versus Acyanotic Congenital Heart Diseases

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Journal Paper

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Journal: Archives of Anesthesiology and Critical Care Year:2025 | Volume:11 | Issue:4 Page(s): 519-524

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Title

Changes in Arterial to End Tidal CO2Difference during Repairing Heart Surgery: Cyanotic Versus Acyanotic Congenital Heart Diseases

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Keywords

Congenital heart defects

Pulmonary gas exchange

Cardiac surgical procedures

Arterial blood gases

Hemodynamics

Abstract

Background: End-tidal carbon dioxide (EtCO2) can approximate the arterial pressure of carbon dioxide (PaCO2) in children without underlying Congenital heart defects. However, EtCO2may underestimate PaCO2in these children, especially during repair procedures. The PaCO2to EtCO2difference (Δ PaCO2-EtCO2) may be significant in children with congenital heart disease (CHD) and can be notably influenced by surgical procedures. Postoperatively, the Δ PaCO2-EtCO2might not remain consistent,thus, arterial blood gas (ABG) analysis may need to be repeated regardless of capnography findings. This hypothesis was tested in our study on children with cyanotic and acyanotic heart defects undergoing corrective surgeries. Methods: In this cross-sectional study, hospital records of all children under 12 years of age with ASA II-III and cyanotic or acyanotic heart defects who were candidates for elective angiography were reviewed. EtCO2was measured by lateral aspiration capnography. Simultaneous measurements of EtCO2and PaCO2were collected before and after the intervention. Results: Significant changes were observed in serum HCO3concentration and the PaO2/FiO2ratio, both of which significantly decreased after the repair surgery. However, the change in Δ PaCO2-EtCO2remained insignificant postoperatively. In the cyanotic group, in addition to a significant reduction in serum HCO3value and an increase in the PaO2/FiO2ratio after the intervention, we found a significant decrease in Δ PaCO2-EtCO2. Conclusion: Arterial blood gas analysis during repair surgery should be repeated in the cyanotic Congenital heart defects group due to the intraoperative variability of Δ PaCO2-EtCO2, but not in the acyanotic heart defects group due to the stability of this difference. Therefore, EtCO2assessed by capnography can estimate PaCO2in children with acyanotic heart defects, but not in those with cyanotic heart defects

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