Increase in the Arterial-to-end-tidal Gradient (Intraabdominal Carbon Dioxide Insufflation in the Pregnant Ewe) 

To the Editor:-In their recently published study on the pregnant ewe, Cruz et al. [1] noted a significant increase in the arterial-to-end-tidal gradient for PCO²during intraabdominal CO²insufflation. They appropriately caution against underestimation of arterial PCO²based on end-tidal CO²monitoring; however, we disagree with their implicit suggestion that arterial blood gas sampling is necessary for laparoscopic surgery during pregnancy. In our clinical experience with laparoscopic cholecystectomy in 10 pregnant patients, [2] monitoring ventilation and circulation with capnography and other customary noninvasive monitors (electrocardiography [ECG], pulse oximetry, noninvasive blood pressure, airway pressures, and expired volumes), we noted no adverse maternal or fetal outcomes. Laparoscopic cholecystectomy can be performed safely and effectively during pregnancy, without invasive monitoring.

Richard A. Steinbrook, M.D.

Sanjay Datta, M.D.

Department of Anesthesia; Brigham and Women's Hospital; 75 Francis Street; Boston, Massachusetts 02115

(Accepted for publication August 24, 1997.)