| Cardiopulmonary dysfunction during minimally invasive thoraco-lumboendoscopic spine surgery. | |
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MedLine Citation:
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PMID: 10357326 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The endoscopic retroperitoneal approach to thoracolumbar anterior spine fusion is associated with CO2 insufflation into the thoracic space. We studied the cardiopulmonary effects of this CO2 thoraco-retroperitoneal insufflation compared with the conventional open surgical procedure using thoraco-phreno-lumbotomy in 12 pigs under balanced anesthesia, paralysis, and mechanical ventilation. During open surgery of the thoracolumbar spine, animals exhibited unchanged systemic and pulmonary hemodynamics, as well as ventilation and oxygenation variables. Animals retroperitoneally insufflated with CO2 (12 mm Hg) exhibited a significant increase of PaCO2 and a moderate decrease of PaO2, SaO2, and pH, with insignificant changes of central venous filling pressures and systemic hemodynamics. Endoscopic phrenotomy with thoracic CO2 insufflation instantaneously and drastically affected hemodynamic status and pulmonary gas exchange with marked hypoxia, hypercapnia, systemic hypotension, tachycardia, and pulmonary hypertension within minutes. An increase of minute ventilation, inspiratory oxygen fraction, and positive end-expiratory pressure promptly reversed these cardiopulmonary effects. CO2 evacuation allowed the animals to completely recover and regain almost baseline cardiopulmonary status, except for a reduced arterial blood pressure. Appropriate monitoring and immediate CO2 desufflation may be beneficial in cases of therapy-resistant hemodynamic, oxygenation, and ventilation difficulties. IMPLICATIONS: For endoscopic thoraco-lumbar spine fusion, CO2 thoraco-retroperitoneum-induced cardiopulmonary dysfunction must be of concern, especially in patients with cardiopulmonary compromise. Appropriate monitoring and immediate CO2 desufflation may be beneficial in cases of therapy-resistant hemodynamic, oxygenation, and ventilation difficulties. |
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Authors:
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B Vollmar; A Olinger; U Hildebrandt; M D Menger |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 88 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1999 Jun |
Date Detail:
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Created Date: 1999-06-15 Completed Date: 1999-06-15 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1244-51 Citation Subset: AIM; IM |
Affiliation:
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Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany. vollmar@cbr.med.harvard.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Blood Gas Analysis Carbon Dioxide Endoscopy / adverse effects* Female Heart / physiopathology* Heart Diseases / etiology, physiopathology Hemodynamics Lung / physiopathology* Lung Diseases / etiology, physiopathology Male Respiration, Artificial Respiratory Function Tests Spinal Fusion* Spine / surgery* Swine |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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