Balouch, Maha

Camporesi, Enrico M

Deng, Jin

Ducoin, Christopher

Mooney, Ashley

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT A Capnography and Transcutaneous CO2Profile of Bariatric Patients during early Postoperative Period after Opioid-Sparing Anesthesia Jin Deng Maha Balouch Ashley Mooney Christopher Ducoin Enrico M. Camporesi Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, Pennsylvania• Capnography and transcutaneous monitoring have increased sensitivity when monitoring bariatric surgery patients in the PACU for respiratory complications, compared to pulse oximetry alone.• Additional research will inform providers on best use of noninvasive PaCO2 monitors and in evaluating cost-benefit analysis of these monitors in clinical practice.A Capnography and Transcutaneous CO2 Profile of Bariatric Patients during early Postoperative Period after Opioid-Sparing AnesthesiaREFERENCES• A total of 33 patients were enrolled and monitored. Patient characteristics are below.• Noninvasive PaCO2 monitors detected six patients who experienced hypercapnia (PCO2 > 45 mmHg) while maintaining SpO2readings above 94%.• Average PTCCO2 values were higher than corresponding PETCO2measurements by 4.5±5.5 mmHg (p<0.05).• Capnography and transcutaneous monitoring have increased sensitivity in detecting early signs of respiratory compromise, compared to pulse oximetry alone.• Capnography tended to underestimate PaCO2compared to transcutaneous monitors, consistent with the literature.• Capnography offers rapid breath-by-breath analysis.• Transcutaneous sensors offer accuracy and patient comfort at the risk of iatrogenic thermal injury and may be affected by poor skin perfusion.• Limitations: small sample size, single-site data collection, did not measure PaCO2 through gold standard arterial blood gas testing.• Future directions: Use outside PACU, additional types of surgery.• SELECT Health Systems: Enhance patient safety and improve outcomes after surgery.• SELECT Leadership: Interprofessionalism in the PACU, new protocols require effective leadership.• IRB-approved written informed consent was obtained from patients aged 18 years or older with body mass index above 30 kg/m2undergoing laparoscopic Roux-en-Y gastric bypass surgery.• Following surgery, patients were monitored in the PACU for vital signs and with capnography and transcutaneous monitors every 5 minutes.• Capnography: Microstream® Smart CapnoLine® Plus O2 Sampling Line• Transcutaneous: SenTec monitor• Primary endpoints included PETCO2, PTCCO2, peripheral oxygen saturation (SpO2), respiratory rate, supplemental oxygen, visual analog scale (VAS) pain scores.• Any adverse respiratory complications were noted e.g. hypoxia, apnea, hypercapnia.• Data were analyzed at three timepoints: PACU admission, 30 minutes after PACU admission, and at PACU discharge.Jin Deng1 (MS), Maha Balouch2 (MS), Ashley Mooney3 (MD), Christopher Ducoin3 (MD), Enrico M. Camporesi2,4 (MD)1University of South Florida Morsani College of Medicine, 2TeamHealth Anesthesia Research Institute, 3University of South Florida Morsani College of Medicine, Department of Surgery, 4TeamHealth Anesthesia[1] Pouwels S, Smeenk FW, Manschot L, et al. Perioperative respiratory care in obese patients undergoing bariatric surgery: Implications for clinical practice. Respir Med. 2016;117:73-80.[2] Fu ES, Downs JB, Schweiger JW, et al. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;126:1552–8.Problem Statement• Eight percent of bariatric surgery patients experience perioperative respiratory complications [1].• Respiratory monitoring in the post-anesthesia care unit (PACU) is traditionally accomplished with pulse oximetry, which measures peripheral oxygen saturation (SpO2).• However, pulse oximetry has impaired ability to detect hypoventilation when patients are provided supplemental oxygen [2].• Alternative continuous noninvasive monitoring of arterial carbon dioxide (PaCO2) can be done with capnography and transcutaneous sensors.• Capnography measures end-tidal carbon dioxide (PETCO2), which approximates PaCO2.• Transcutaneous monitors use electrochemical sensors placed on the skin to measure PTCCO2, which also approximates PaCO2This study evaluates the usefulness of capnography and transcutaneous carbon dioxide monitoring in bariatric surgery patients at increased risk of postoperative respiratory complications in the PACU. 

A Capnography and Transcutaneous CO2Profile of Bariatric Patients during early Postoperative Period after Opioid-Sparing Anesthesia

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1372&context=select-program

A Capnography and Transcutaneous CO2Profile of Bariatric Patients during early Postoperative Period after Opioid-Sparing Anesthesia

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