Document Detail


Transcutaneous PCO2 monitoring during laparoscopic cholecystectomy in pregnancy.
MedLine Citation:
PMID:  9512853     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring (PtcCO2) as an approach to optimise ventilation during laparoscopic surgery in pregnancy. METHOD: A healthy parturient received general anaesthesia for laparoscopic cholecystectomy. Pulmonary ventilation was adjusted to maintain end-tidal carbon dioxide (conventional PETCO2) at 32 mmHg during CO2 insufflation. A PtcCO2 monitor was used to trend PaCO2 throughout the procedure. Mechanical ventilation was interrupted every five minutes to obtain an end-tidal PCO2 value at large tidal volume (squeeze PETCO2). RESULTS: The PtcCO2 increased from 39 mmHg before induction to 45 mmHg after CO2 insufflation. This corresponds to an estimated maximum PaCO2 of 39-40 mmHg during insufflation. The PtcCO2 gradually returned to pre-induction baseline values one hour after the termination of CO2 insufflation. Squeeze PETCO2 values approximated PtcCO2 more closely than did conventional PETCO2 values (P < 0.01). CONCLUSION: Continuous PtcCO2 measurements as well as squeeze PETCO2 may be of clinical value in trending and preventing hypercarbia during laparoscopic surgery.
Authors:
K Bhavani-Shankar; R A Steinbrook; P S Mushlin; D Freiberger
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  45     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-04-30     Completed Date:  1998-04-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  164-9     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Gas Monitoring, Transcutaneous*
Carbon Dioxide / blood*
Cholecystectomy*
Female
Humans
Laparoscopy*
Pregnancy
Respiratory Mechanics / physiology
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

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


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