| Effect of arterial blood pressure on the arterial to end-tidal carbon dioxide difference during anesthesia induction in patients scheduled for craniotomy. | |
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MedLine Citation:
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PMID: 20622686 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Before obtaining results of arterial blood gas analysis in mechanically ventilated patients undergoing neurosurgery, the volume of ventilation is primarily adjusted according to endtidal CO2 (EtCO2). We characterized the impact of various arterial blood pressure changes on arterial PCO2 (PaCO2) to EtCO2 differences (PaCO2-EtCO2) in patients anesthetized for craniotomy. METHODS: Seventy-two elective craniotomy patients were enrolled in this prospective study. Noninvasive blood pressure was measured before anesthesia induction. Anesthesia was induced with thiopental, rocuronium or suxamethonium, and fentanyl and was maintained with inhaled anesthetics or propofol and remifentanil. Volume-controlled ventilation was adjusted after intubation according to the clinical judgment. The first arterial blood gas analysis was taken just before the head pinning. Systolic, diastolic, and mean arterial blood pressures (MAP) and heart rate were registered after intubation every 5 minutes until the head pinning. RESULTS: PaCO2-EtCO2 correlated positively with percentage difference between MAP awake at arrival in operating room and during arterial CO2 determination (P=0.0008, r=0.388). In analysis according to a MAP decrease of less than 20% (n=17), 20% to 29% (n=24), 30% to 35% (n=16), and more than 35% (n=15), the mean (SD) PaCO2-EtCO2 was greater in patients with MAP decrease of over 35% or 30% to 35% than in patients with MAP decrease of less than 20%. The mean (SD) absolute values of the PaCO2-EtCO2 were 0.96 (0.43) kPa or 0.85 (0.31) kPa versus 0.55 (0.24) kPa, respectively (P<0.05 between categories). Mean EtCO2 was not different in the various MAP difference categories, but PaCO2 was greatest when MAP decreased more than 35% (P<0.05). CONCLUSIONS: There was a positive correlation between PaCO2-EtCO2 and MAP decrease shortly after induction of anesthesia. PaCO2-EtCO2 is recommended to be interpreted together with change in MAP during early phase of neuroanesthesia to guarantee optimal mechanical ventilation. |
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Authors:
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Teemu Luostarinen; Ozlem Korkmaz Dilmen; Tomohisa Niiya; Tomi Niemi |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of neurosurgical anesthesiology Volume: 22 ISSN: 1537-1921 ISO Abbreviation: J Neurosurg Anesthesiol Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-16 Completed Date: 2011-01-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8910749 Medline TA: J Neurosurg Anesthesiol Country: United States |
Other Details:
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Languages: eng Pagination: 303-8 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. teemu.luostarinen@hus.fi |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia, Inhalation* Blood Gas Analysis Blood Pressure / physiology* Body Temperature Carbon Dioxide / blood* Craniotomy* Female Humans Hydrogen-Ion Concentration Intubation, Intratracheal Male Middle Aged Neurosurgical Procedures Prospective Studies Respiration, Artificial Respiratory Mechanics Spirometry |
| 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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