Permissive hypercapnia during thoracic anaesthesia

Citation
H. Morisaki et al., Permissive hypercapnia during thoracic anaesthesia, ACT ANAE SC, 43(8), 1999, pp. 845-849
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ACTA ANAESTHESIOLOGICA SCANDINAVICA
ISSN journal
0001-5172 → ACNP
Volume
43
Issue
8
Year of publication
1999
Pages
845 - 849
Database
ISI
SICI code
0001-5172(199909)43:8<845:PHDTA>2.0.ZU;2-8
Abstract
Background: While permissive hypercapnia is commonly practised in critical care, it remains unclear if the comparable manoeuvres are clinically accept able during anaesthesia. This retrospective study aimed at describing the a naesthetic implications of hypercapnia associated with deliberate hypoventi lation during thoracic surgery in patients with severe emphysema. Methods: Thirteen patients with emphysema who required thoracic surgery und er similar anaesthesia were reviewed: 3 patients were managed to maintain n ormocapnia (normocapnia group) whereas 10 patients developed hypercapnia (P aCO2 >70 mmHg) as a result of restricting peak airway pressures (hypercapni a group). Results: In the normocapnia group (PaCO2: 45+/-1 mmHg, mean+/-SD), no event which required therapeutic intervention during the surgery was seen, where as 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 pa tients required inotropic support to prevent hypotension, 1 patients requir ed tracheal gas insufflation of oxygen to the operated lung to avoid hypoxa emia and 3 patients required lidocaine to treat ventricular arrhythmia. How ever, the trachea was extubated in the operation theatre in 9 of 10 patient s and no organ dysfunction was observed postoperatively. Four patients show ed postoperative air leak on the first postoperative day, one of which pers isted over 5 days. Conclusion: Although there are some limitations, this preliminary study ind icates that hypercapnia around 100 mmHg during anaesthesia for thoracic sur gery may not be associated with serious consequences.