Document Detail

Permissive hypercapnia during thoracic anaesthesia.
MedLine Citation:
PMID:  10492414     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: While permissive hypercapnia is commonly practised in critical care, it remains unclear if the comparable manoeuvres are clinically acceptable during anaesthesia. This retrospective study aimed at describing the anaesthetic implications of hypercapnia associated with deliberate hypoventilation during thoracic surgery in patients with severe emphysema. METHODS: Thirteen patients with emphysema who required thoracic surgery under similar anaesthesia were reviewed: 3 patients were managed to maintain normocapnia (normocapnia group) whereas 10 patients developed hypercapnia (PaCO2 >70 mmHg) as a result of restricting peak airway pressures (hypercapnia group). RESULTS: In the normocapnia group (PaCO2: 45+/-1 mmHg, mean+/-SD), no event which required therapeutic intervention during the surgery was seen, whereas 2 of 3 patients showed postoperative air leakage which persisted over 5 days. In the hypercapnia group, the maximum PaCO2 during anaesthesia ranged between 70 mmHg and 135 mmHg (98-21 mmHg). During anaesthesia, all 10 patients required inotropic support to prevent hypotension, 4 patients required tracheal gas insufflation of oxygen to the operated lung to avoid hypoxaemia and 3 patients required lidocaine to treat ventricular arrhythmia. However, the trachea was extubated in the operation theatre in 9 of 10 patients and no organ dysfunction was observed postoperatively. Four patients showed postoperative air leak on the first postoperative day, one of which persisted over 5 days. CONCLUSION: Although there are some limitations, this preliminary study indicates that hypercapnia around 100 mmHg during anaesthesia for thoracic surgery may not be associated with serious consequences.
H Morisaki; R Serita; Y Innami; Y Kotake; J Takeda
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  43     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-19     Completed Date:  1999-10-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  845-9     Citation Subset:  IM; S    
Department of Anaesthesiology, School of Medicine, Keio University, Tokyo, Japan.
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MeSH Terms
Anesthesia, General*
Anti-Arrhythmia Agents / therapeutic use
Arrhythmias, Cardiac / drug therapy
Carbon Dioxide / blood*
Cardiotonic Agents / therapeutic use
Critical Care
Follow-Up Studies
Hypercapnia / blood*
Hypotension / prevention & control
Hypoventilation / blood
Intraoperative Complications / prevention & control
Intubation, Intratracheal
Lidocaine / therapeutic use
Middle Aged
Operating Rooms
Oxygen Inhalation Therapy
Pneumonectomy* / adverse effects
Pneumothorax / etiology
Pulmonary Emphysema / surgery
Retrospective Studies
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Cardiotonic Agents; 124-38-9/Carbon Dioxide; 137-58-6/Lidocaine

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