{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T16:39:24Z","timestamp":1758127164121,"version":"3.37.3"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Peroral endoscopic myotomy (POEM) has become a recognized treatment for achalasia. The technique requires CO2 insufflation. It is estimated that the partial pressure of CO2 (PaCO2) is 2 to 5\u200amm Hg higher than the end tidal CO2 (etCO2), and etCO2 is used as a surrogate for PaCO2 because PaCO2 requires an arterial line. However, no study has compared invasive and noninvasive CO2 monitoring during POEM.<\/jats:p><jats:p>\n          Patients and methods\u2002Seventy-one patients who underwent POEM were included in a prospective comparative study. PaCO2 plus etCO2 was measured in 32 patients (invasive group) and etCO2 only in 39 matched patients (noninvasive group). Pearson correlation coefficient (PCC) and Spearman\u2019s Rho were used to calculate the correlation between PaCO2 and ETCO2.<\/jats:p><jats:p>\n          Results\u2002PaCO2 and ETCO2 were strongly correlated: PCC R value: 0.8787 P\u200a\u2264\u200a0.00001, Spearman\u2019s Rho R value: 0.8775, P\u200a\u2264\u200a0.00001.\u200aWithin the invasive group, the average difference between PaCO2 and ETCO2 was 3.39\u200amm Hg (median 3, standard deviation 3.5), within the 2- to 5-mm Hg range. The average procedure time (scope in to scope out) was increased 17.7 minutes (P\u200a=\u200a0.044) and anesthesia duration was 46.3 minutes. Adverse events (AEs) included three hematomas and one nerve injury in the invasive group and one pneumothorax in the noninvasive group.\u200aThere were no differences in AE rates between the groups (13\u200a% vs 3\u200a% P\u200a=\u200a0.24).<\/jats:p><jats:p>\n          Conclusions\u2002Universal PaCO2 monitoring contributes to increased procedure and anesthesia times without any decrease in AEs in patients undergoing POEM. CO2 monitoring with an arterial line should only be performed in patients with major cardiovascular comorbidities; in all other patients, ETCO2 is an appropriate tool.<\/jats:p>","DOI":"10.1055\/a-2048-1312","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T02:07:43Z","timestamp":1678154863000},"page":"E468-E473","source":"Crossref","is-referenced-by-count":1,"title":["Invasive CO2 monitoring with arterial line compared to end tidal CO2 during peroral endoscopic myotomy"],"prefix":"10.1055","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct05041608","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-4072","authenticated-orcid":false,"given":"Rodrigo","family":"Duarte-Chavez","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Tyberg","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avik","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haroon M.","family":"Shahid","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhargav","family":"Vemulapalli","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sardar","family":"Shah-Khan","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Gaidhane","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0836-6114","authenticated-orcid":false,"given":"Michel","family":"Kahaleh","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United 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disorders \u2013 part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"B Weusten","year":"2020","journal-title":"Endoscopy"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/MCG.0000000000001296","article-title":"Third space endoscopy: lessons learnt from a decade of submucosal endoscopy","volume":"54","author":"A Bapaye","year":"2020","journal-title":"J Clin Gastroenterol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s10877-018-0122-7","article-title":"Bladder pressure monitoring and CO2 gas-related adverse events during per-oral endoscopic myotomy","volume":"32","author":"M Yamashita-Ichimura","year":"2018","journal-title":"J Clin Monit Comput"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"832","DOI":"10.4187\/respcare.07812","article-title":"Monitoring during mechanical ventilation","volume":"65","author":"C R Rackley","year":"2020","journal-title":"Respir Care"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1056\/NEJMvcm1105237","article-title":"Monitoring ventilation with capnography","volume":"367","author":"R Ortega","year":"2012","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s44158-022-00054-7","article-title":"Pediatric anesthesia and achalasia: 10 years\u2019 experience in peroral endoscopy myotomy management","author":"F Sbaraglia","year":"2022","journal-title":"J Anesth Analg Crit Care"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1007\/s00540-013-1735-0","article-title":"Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series","volume":"28","author":"E Tanaka","year":"2014","journal-title":"J Anesth"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S0016-5107(86)71891-9","article-title":"Who's for CO2?","volume":"32","author":"C B Williams","year":"1986","journal-title":"Gastrointest Endosc"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"145","DOI":"10.7326\/M16-0209","article-title":"Who is for CO2? 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Ren","year":"2012","journal-title":"Surg Endosc"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"379","DOI":"10.4103\/0970-9185.188829","article-title":"Anesthesia for peroral endoscopic myotomy: A retrospective case series","volume":"32","author":"N Jayan","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"3030","DOI":"10.1007\/s00464-014-4040-6","article-title":"Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis","volume":"29","author":"R Talukdar","year":"2015","journal-title":"Surg Endosc"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.gie.2014.05.004","article-title":"Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia","volume":"80","author":"M Y Cai","year":"2014","journal-title":"Gastrointest 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end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients","volume":"1","author":"E Razi","year":"2012","journal-title":"Arch Trauma Res"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/01.pec.0000159064.24820.bd","article-title":"End-tidal carbon dioxide monitoring in pediatric emergencies","volume":"21","author":"K J Sullivan","year":"2005","journal-title":"Pediatr Emerg Care"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s12630-017-0820-5","article-title":"Anesthetic considerations for patients with esophageal achalasia undergoing peroral endoscopic myotomy: a retrospective case series review","volume":"64","author":"B Loser","year":"2017","journal-title":"Can J Anaesth"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.4187\/respcare.06094","article-title":"Comparison of End-Tidal, Arterial, Venous, and Transcutaneous PCO2","volume":"64","author":"S Fujimoto","year":"2019","journal-title":"Respir Care"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"475","DOI":"10.4103\/1793-5482.180959","article-title":"A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients","volume":"12","author":"P Gaur","year":"2017","journal-title":"Asian J Neurosurg"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1378\/chest.92.5.832","article-title":"Comparison of arterial-end-tidal PCO2 difference and dead space\/tidal volume ratio in respiratory failure","volume":"92","author":"M K Yamanaka","year":"1987","journal-title":"Chest"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/0888-6296(90)90457-Q","article-title":"The arterial-end-tidal CO2 difference during cardiothoracic surgery","volume":"4","author":"R Fletcher","year":"1990","journal-title":"J Cardiothorac Anesth"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/00000542-198902000-00007","article-title":"Physiologic dead space, venous admixture, and the arterial to end-tidal carbon dioxide difference in infants and children undergoing cardiac surgery","volume":"70","author":"F A Burrows","year":"1989","journal-title":"Anesthesiology"}],"container-title":["Endoscopy International 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