Accuracy of Transcutaneous Carbon Dioxide Measurement During Transcatheter Aortic Valve Replacement Under Monitored Anesthesia Care: A Prospective Observational Study

Yuki Okazawa; Yuki Kataoka; Kazuo Shindo

doi:10.7759/cureus.53661

Accuracy of Transcutaneous Carbon Dioxide Measurement During Transcatheter Aortic Valve Replacement Under Monitored Anesthesia Care: A Prospective Observational Study

Cureus. 2024 Feb 5;16(2):e53661. doi: 10.7759/cureus.53661. eCollection 2024 Feb.

Authors

Yuki Okazawa^{1

2}, Yuki Kataoka^{3

4

5

6}, Kazuo Shindo²

Affiliations

¹ Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN.
² Department of Anesthesia, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN.
³ Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN.
⁴ Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN.
⁵ Department of Systematic Reviewers, Scientific Research Works Peer Support Group, Osaka, JPN.
⁶ Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN.

Abstract

Background Transcutaneous carbon dioxide tension (PtcCO₂) measurement is a promising alternative to arterial carbon dioxide tension (PaCO₂) measurement. PaCO₂ measurement is invasive and intermittent, whereas PtcCO₂ measurement is non-invasive and continuous. However, previous studies evaluating PtcCO₂measurements did not include patients undergoing transcatheter aortic valve replacement (TAVR), who experience anticipated hemodynamic changes, particularly before and after valve placement. Therefore, we investigated whether PtcCO₂ measurement could provide an alternative to PaCO₂ measurement during transfemoral TAVR under monitored anesthesia care (MAC) with local anesthesia. Methodology We conducted a prospective observational study. We included all consecutive patients with severe aortic stenosis who were scheduled to undergo a transfemoral TAVR under MAC at our institution from November 1, 2020, to April 30, 2021. During the procedures, PaCO₂ and PtcCO₂ were concurrently monitored six times as a reference standard and index test, respectively. PtcCO₂ was monitored continuously using a non-invasive earlobe sensor. The agreement between PtcCO₂ and PaCO₂ measurements was assessed using the Bland-Altman method, and the 95% limits of agreement were calculated. Based on previous studies, we determined that 95% limits of agreement of ±6.0 mmHg would be clinically acceptable to define PtcCO₂ as an alternative to PaCO₂. Results We obtained 88 measurement pairs from 15 patients. The lower and upper 95% limits of agreement between the PtcCO₂ and PaCO₂ measurements were -4.22 mmHg and 6.56 mmHg, respectively. Conclusions During TAVR under MAC with local anesthesia, PtcCO₂ measurement could not provide a viable alternative to PaCO₂ measurement to reduce high PaCO2 events. This study focused on comparing intraoperative periods before and after valve implantation. Therefore, further investigation is warranted to assess the impact of various factors, including the prosthetic valve type and the hemodynamic effects of balloon aortic valvuloplasty, on PtcCO₂ measurement in TAVR.

Keywords: monitored anesthesia care (mac); non-invasive monitoring; procedural sedation and analgesia; transcatheter aortic valve repair; transcutaneous carbon dioxide tension.