Document Detail


Pulsus alternans during general anesthesia with halothane: effects of permissive hypercapnia.
MedLine Citation:
PMID:  10861150     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulsus alternans is a classic type of abnormal pulse. It can be defined as a regular alternation of pulse amplitude in which runs of weak and strong beats follow each other alternatively without any change in cycle length. It may be a sign of severe decompensated congestive heart failure. The authors infrequently encountered some cases of pulsus alternans during halothane anesthesia with spontaneous respiration in otherwise normal subjects in association with high levels of end-tidal carbon dioxide. This study was conducted to determine if there is any relation between this phenomena and hypercapnia. METHODS: One hundred twenty patients undergoing elective lower extremity surgery were selected. Halothane was used for maintenance of anesthesia, and the patients were allowed to breath spontaneously. The occurrence of pulsus alternans was determined by plethysmographic display of pulse wave and then confirmed by palpation of the radial artery. RESULTS: Ten patients (8.3%) developed pulsus alternans together with elevated levels of end-tidal carbon dioxide (57 +/- 4 mmHg vs. 41 +/- 4 mmHg in patients without pulsus alternans [mean +/- SD]). The pulsus alternans disappeared after switching to controlled ventilation and 15-20% reduction in end-tidal carbon dioxide. During the period of pulsus alternans, vital signs and electrocardiography remained within normal limits. CONCLUSIONS: There may be some relation between occurrence of pulsus alternans and hypercapnia during halothane anesthesia. Pulsus alternans occurs in a small fraction of spontaneously breathing, halothane-anesthetized patients. Although hypercapnia is clearly a factor, the mechanism of this phenomenon is unknown.
Authors:
M Saghaei; M Mortazavian
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  93     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-07     Completed Date:  2000-08-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  91-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Critical Care, Esfahan University of Medical Sciences, Iran. msaqaei@noornet.net
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, Inhalation*
Anesthetics, Inhalation / pharmacology*
Blood Pressure
Carbon Dioxide / metabolism
Halothane / pharmacology*
Humans
Hypercapnia / physiopathology*
Leg / surgery
Linear Models
Middle Aged
Oximetry
Plethysmography
Pulse*
Radial Artery
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 124-38-9/Carbon Dioxide; 151-67-7/Halothane

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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