Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Guacho, John Alexander Lata; Ribeiro, Igor Braga; Moura, Bruna Furia Buzetti Hourneaux de; Gallegos, Megui Marilia Mansilla; McCarty, Thomas R.; Toma, Ricardo Katsuya; Moura, Eduardo Guimarães Hourneaux de

doi:10.5946/ce.2020.275

Cited by 2 publications

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“…In one ( 6 ), pain reduction was only evident following adjusting for baseline abdominal pain, and no such benefit was observed in another ( 8 ). A recent meta-analysis concluded that there is limited evidence to recommend routine use of CO 2 in pediatric endoscopy ( 12 ), while another concluded that CO 2 gas is preferred for pediatric colonoscopy ( 13 ). Furthermore, peak end-tidal CO 2 (EtCO 2 ) measurement in 2 of the pediatric studies showed higher EtCO 2 in the CO 2 group, raising concerns about systemic absorption of CO 2 ( 6 , 8 ).…”

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Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?

Dike¹,

Pacheco²,

Lyden³

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Background: Inflation of the gastrointestinal lumen is vital for proper visualization during endoscopy. Air, insufflated via the endoscope, is gradually being replaced with carbon dioxide (CO 2 ) in many centers, with the intention of minimizing post-procedural discomfort due to retained gas. Recent studies suggest that the use of CO 2 during pediatric esophagogastroduodenoscopy (EGD) with an unprotected airway is associated with transient elevations in exhaled CO 2 (end-tidal CO 2 , EtCO 2 ), raising safety concerns. One possible explanation for these events is eructation of insufflation gas from the stomach. Objectives: To distinguish eructated versus absorbed CO 2 by sampling EtCO 2 from a protected airway with either laryngeal mask airway (LMA) or endotracheal tube (ETT), and to observe for changes in minute ventilation (MV) to exclude hypoventilation events. Methods: Double-blinded, randomized clinical trial of CO 2 versus air insufflation for EGD with airway protection by either LMA or ETT. Tidal volume, respiratory rate, MV, and EtCO 2 were automatically recorded every minute. Cohort demographics were described with descriptive characteristics. Variables including the percent of children with peak, transient EtCO 2 ≥ 60 mmHg were compared between groups. Results: One hundred ninety-five patients were enrolled for 200 procedures. Transient elevations in EtCO 2 of ≥60 mmHg were more common in the CO 2 group, compared to the air group (16% vs 5%, P = 0.02), but were mostly observed with LMA and less with ETT. Post-procedure pain was not different between groups, but flatulence was reported more with air insufflation ( P = 0.004). Conclusion: Transient elevations in EtCO 2 occur more often with CO 2 than with air insufflation during pediatric EGD despite protecting the airway with an LMA or, to a lesser degree, with ETT. These elevations were not associated with changes in MV. Although no adverse clinical effects from CO 2 absorption were observed, these findings suggest that caution should be exercised when considering the use of CO 2 insufflation, especially since the observed benefits of using this gas were minimal.

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