Aim: End-tidal CO 2 (Et CO2 ) is the standard in operative care along with pulse oximetry for ventilation assessment. It is known to be less accurate in the infant population than in adults. Many neonatal intensive care units (NICU) have converted to utilizing transcutaneous CO 2 (tcP CO2 ) monitoring. This study aimed to compare perioperative Et CO2 to tcP CO2 in the pediatric perioperative population specifically below 10 kg, which encompasses neonates and some infants. Methods: After IRB approval and parental written informed consent, we enrolled neonates and infants weighing less than 10 kg, who were scheduled for elective surgery with endotracheal tube under general anesthesia. P CO2 was monitored with Et CO2 and with tcP CO2 . Venous blood gas (Pv CO2 ) samples were drawn at the end of the anesthetic. We calculated a mean difference of Et CO2 minus Pv CO2 (Delta Et CO2 ), and tcP CO2 minus Pv CO2 (Delta tcP CO2 ) from end-of-case measurements. The mean differences in the NICU and non-NICU patients were compared by t-tests and Bland–Altman analysis. Results: Median age was 10.9 weeks, and median weight was 4.4 kg. NICU (n=6) and non-NICU (n=14) patients did not differ in Pv CO2 . Relative to the Pv CO2 , the Delta Et CO2 was much greater in the NICU compared to the non-NICU patients (−28.1 versus −9.8, t=3.912, 18 df, P =0.001). Delta tcP CO2 was close to zero in both groups. Although both measures obtained simultaneously in the same patients agreed moderately with each other (r =0.444, 18 df, P =0.05), Bland–Altman plots indicated that the mean difference (bias) in Et CO2 measurements differed significantly from zero ( P <0.05). Conclusions: Et CO2 underestimates Pv CO2 values in neonates and infants under general anesthesia. TcP CO2 closely approximates venous blood gas values, in both the NICU and non-NICU samples. We, therefore, conclude that tcP CO2 is a more accurate measure of operative Pv CO2 in infants, especially in NICU patients.

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Background:The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric postdischarge nausea and vomiting.Aims: This preliminary study aimed to identify the factors affecting postdischarge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory. Methods:One hundred and twenty-two pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study. After obtaining written parental consent and patient assent when indicated, child self-ratings of nausea and pain were completed preoperatively and at discharge, and for 3 days postdischarge. Questionnaires were returned by mail, with a 64% return rate.Using stepwise logistic regression with backward elimination, three separate analyses were undertaken to predict the following outcomes: nausea present in recovery, nausea present on postoperative day 1, and emesis on day of surgery.Results: Nearly half (47%) of our cohort experienced nausea at the time of discharge; 11% had emesis on day of surgery. On postoperative day 1, there was a 15% incidence of nausea with a 3% incidence of emesis. In the multiple logistic regression analyses, nausea at discharge was predicted by male gender (odds ratio 2.5, 95% CI:1.0-6.2) and the presence of pain on discharge (odds ratio 3.0, 95% CI: 1.0-9.2).Emesis on day of surgery was predicted by the presence of nausea at discharge (odds ratio 16.9, 95% CI: 1.8-159.3) and having a family history of nausea/vomiting (odds ratio 8.3, 95% CI: 1.6-43.4). The presence of nausea on postoperative day 1 was predicted only by the presence of nausea on discharge (odds ratio 3.7, 95% CI: 1.2-11.1). Conclusion:Our preliminary data indicate that postoperative nausea and vomiting may persist into the postdischarge period and pain may be a contributing factor. K E Y W O R D S