Arterial to End-tidal Carbon Dioxide Pressure Difference during Laparoscopic Surgery in Pregnancy

2000 ◽  
Vol 93 (2) ◽  
pp. 370-373 ◽  
Author(s):  
Kodali Bhavani-Shankar ◽  
Richard A. Steinbrook ◽  
David C. Brooks ◽  
Sanjay Datta
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Pulmonary Ventilation ◽  
Respiratory Acidosis ◽  
Gas Analysis ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal

Background There is controversy about whether capnography is adequate to monitor pulmonary ventilation to reduce the risk of significant respiratory acidosis in pregnant patients undergoing laparoscopic surgery. In this prospective study, changes in arterial to end-tidal carbon dioxide pressure difference (PaCO2--PetCO2), induced by carbon dioxide pneumoperitoneum, were determined in pregnant patients undergoing laparoscopic cholecystectomy. Methods Eight pregnant women underwent general anesthesia at 17-30 weeks of gestation. Carbon dioxide pnueumoperitoneum was initiated after obtaining arterial blood for gas analysis. Pulmonary ventilation was adjusted to maintain PetCO2 around 32 mmHg during the procedure. Arterial blood gas analysis was performed during insufflation, after the termination of insufflation, after extubation, and in the postoperative period. Results The mean +/- SD for PaCO2--PetCO2 was 2.4 +/- 1.5 before carbon dioxide pneumoperitoneum, 2.6 +/- 1.2 during, and 1.9 +/- 1.4 mmHg after termination of pneumoperitoneum. PaCO2 and pH during pneumoperitoneum were 35 +/- 1.7 mmHg and 7.41 +/- 0.02, respectively. There were no significant differences in either mean PaCO2--PetCO2 or PaCO2 and pH during various phases of laparoscopy. Conclusions Capnography is adequate to guide ventilation during laparoscopic surgery in pregnant patients. Respiratory acidosis did not occur when PetCO2 was maintained at 32 mmHg during carbon dioxide pneumoperitoneum.

Intraabdominal Carbon Dioxide Insufflation in the Pregnant Ewe

1996 ◽  
Vol 85 (6) ◽  
pp. 1395-1402. ◽  
Author(s):  
Antonio M. Cruz ◽  
Lucy C. Southerland ◽  
Tanya Duke ◽  
Hugh G. G. Townsend ◽  
James G. Ferguson ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Intraabdominal Pressure ◽  
Control Group ◽  
Uterine Blood Flow ◽  
Carbon Dioxide Insufflation ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Background Laparoscopic surgical procedures are being performed in pregnant women with increasing frequency. Maternal-fetal physiologic changes occurring during intraabdominal carbon dioxide insufflation are poorly understood, and maternal-fetal safety is of concern during carbon dioxide pneumoperitoneum. A previous pilot study using end-tidal carbon dioxide-guided ventilation resulted in maternal and fetal acidosis and tachycardia during carbon dioxide pneumoperitoneum. Using serial arterial PCO2 to guide ventilation, this study was designed to evaluate maternal-fetal cardiopulmonary status, uterine blood flow, and the intraamniotic pressure effects of intraabdominal carbon dioxide insufflation in singleton pregnant ewes between 120 and 135 days of gestation. Methods In a prospective randomized cross-over study, nine ewes were to receive either abdominal insufflation with carbon dioxide to an intraabdominal pressure of 15 mmHg (n = 9; insufflation group) or receive no insufflation (n = 9; control group). Anesthesia was induced with thiopental and maintained with end-tidal halothane (1 to 1.5 minimum alveolar concentration/100% oxygen). Mechanical ventilation was guided by serial maternal arterial blood gas analysis to maintain PaCO2 between 35 and 40 mmHg. Data from insufflated animals were collected during insufflation (60 min) and after desufflation (30 min). Control group data were collected and matched to similar time intervals for 90 min. Ewes were allowed to recover, and after a rest period (48 h) they were entered in the cross-over study. Results During insufflation there was a significant increase (P < 0.05) in maternal PaCO2 to end-tidal carbon dioxide gradient and minute ventilation, with concomitant decreases in maternal end-tidal carbon dioxide and PaO2. Intraamniotic pressure increased significantly during insufflation. No significant changes were observed in maternal hemodynamic variables, fetal variables, or in uterine blood flow during the study. There were no fetal deaths or preterm labor in any of the animals during the experiment. Conclusions During the 1-h insufflation, a marked increase in PaCO2-to-end-tidal carbon dioxide gradient was observed, suggesting that capnography may be an inadequate guide to ventilation during carbon dioxide pneumoperitoneum in the pregnant patient. No other significant circulatory changes were observed.

scholarly journals End-Tidal Carbon Dioxide Pressure Measurement after Prolonged Inspiratory Time Gives a Good Estimation of the Arterial Carbon Dioxide Pressure in Mechanically Ventilated Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2219
Author(s):  
Arthur Salomé ◽  
Annabelle Stoclin ◽  
Cyrus Motamed ◽  
Philippe Sitbon ◽  
Jean-Louis Bourgain
Keyword(s):  
Carbon Dioxide ◽  
Distress Syndrome ◽  
Inspiratory Time ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Expiratory Time ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal

Background: End-tidal carbon dioxide pressure (PetCO2) is unreliable for monitoring PaCO2 in several conditions because of the unpredictable value of the PaCO2–PetCO2 gradient. We hypothesised that increasing both the end-inspiratory pause and the expiratory time would reduce this gradient in patients ventilated for COVID-19 with Acute Respiratory Distress Syndrome and in patients anaesthetised for surgery. Methods: On the occasion of an arterial blood gas sample, an extension in inspiratory pause was carried out either by recruitment manoeuvre or by extending the end-inspiratory pause to 10 s. The end-expired PCO2 was measured (expiratory time: 4 s) after this manoeuvre (PACO2) in comparison with the PetCO2 measured by the monitor. We analysed 67 Δ(a-et)CO2, Δ(a-A)CO2 pairs for 7 patients in the COVID group and for 27 patients in the anaesthesia group. Results are expressed as mean ± standard deviation. Results: Prolongation of the inspiratory pause significantly reduced PaCO2–PetCO2 gradients from 11 ± 5.7 and 5.7 ± 3.4 mm Hg (p < 0.001) to PaCO2–PACO2 gradients of −1.2 ± 3.3 (p = 0.043) and −1.9 ± 3.3 mm Hg (p < 0.003) in the COVID and anaesthesia groups, respectively. In the COVID group, PACO2 showed the lowest dispersion (−7 to +6 mm Hg) and better correlation with PaCO2 (R2 = 0.92). The PACO2 had a sensitivity of 0.81 and a specificity of 0.93 for identifying hypercapnic patients (PaCO2 > 50 mm Hg). Conclusions: Measuring end-tidal PCO2 after prolonged inspiratory time reduced the PaCO2–PetCO2 gradient to the point of obtaining values close to PaCO2. This measure identified hypercapnic patients in both intensive care and during anaesthesia.

Exercise end-tidal carbon dioxide pressure: a new prognostic marker after acute myocardial infarction?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
P Rio ◽  
A Castelo ◽  
I Cardoso ◽  
S Silva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carbon Dioxide ◽  
Acute Myocardial Infarction ◽  
Prognostic Marker ◽  
Systolic Function ◽  
Prognostic Role ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal ◽  
Maximal Effort

Abstract Funding Acknowledgements Type of funding sources: None. Background Although several cardiopulmonary exercise testing (CPET) parameters have already proved to predict prognosis, there is increasing interest in finding variables that do not require maximal effort. End-tidal carbon dioxide pressure (PETCO2), an indirect indicator of cardiac output, is one of such variables. Studies in heart failure populations already suggest its role as a prognostic factor. However, data concerning other populations are still scarce. Purpose To assess the association between exercise PETCO2, cardiac biomarkers and systolic function following acute myocardial infarction (AMI) and to evaluate its potential prognostic role in this population. Methods A retrospective single-centre analysis was conducted including patients who underwent symptom-limited CPET early after AMI. We assessed PETCO2 at baseline (PETCO2-B), at anaerobic threshold (PETCO2-AT) and at peak exercise and calculated the difference between PETCO2-AT and PETCO2-B (PETCO2-difference). We analysed their association with B-natriuretic peptide (BNP), maximal troponin after AMI as well as with left ventricular ejection fraction (LVEF) 1 year after. Results We included 40 patients with a mean age of 56 years (87.5% male), assessed with CPET a median of 3 months after AMI (80% of which were ST-elevation myocardial infarctions). Average respiratory exchange ratio was 1,1 with 48% of patients not reaching maximal effort. Mean PETCO2-AT was 37mmHg, with a mean increase from baseline of 6mmHg (PETCO2-difference). There was a significant positive correlation between all the PETCO2 variables measured and BNP values at time of AMI and on follow-up (best correlation for PETCO2-AT with BNP at AMI hospitalization, r = 0.608, p &lt; 0.001). Maximal troponin was not correlated with PETCO2. Both PETCO2-AT and PETCO2-difference were significantly and positively correlated with LVEF 1-year post-AMI (r = 0.421, p = 0.040 and r = 0.511, p = 0.011, respectively). Conclusion PETCO2-AT and PETCO2-difference are both correlated with BNP, an established prognostic marker, and with medium-term systolic function after AMI, suggesting their potential prognostic role in this population. Further studies with larger samples are required to confirm the results of this pilot study and assess PETCO2 as a definite predictor of prognosis after AMI.

scholarly journals Accuracy of Postoperative End-tidal Pco2Measurements with Mainstream and Sidestream Capnography in Non-obese Patients and in Obese Patients with and without Obstructive Sleep Apnea

2009 ◽  
Vol 111 (3) ◽  
pp. 609-615 ◽  
Author(s):  
Yusuke Kasuya ◽  
Ozan Akça ◽  
Daniel I. Sessler ◽  
Makoto Ozaki ◽  
Ryu Komatsu
Keyword(s):  
Carbon Dioxide ◽  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Cannula ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal

Background Obtaining accurate end-tidal carbon dioxide pressure measurements via nasal cannula poses difficulties in postanesthesia patients who are mouth breathers, including those who are obese and those with obstructive sleep apnea (OSA); a nasal cannula with an oral guide may improve measurement accuracy in these patients. The authors evaluated the accuracy of a mainstream capnometer with an oral guide nasal cannula and a sidestream capnometer with a nasal cannula that did or did not incorporate an oral guide in spontaneously breathing non-obese patients and obese patients with and without OSA during recovery from general anesthesia. Methods The study enrolled 20 non-obese patients (body mass index less than 30 kg/m) without OSA, 20 obese patients (body mass index greater than 35 kg/m) without OSA, and 20 obese patients with OSA. End-tidal carbon dioxide pressure was measured by using three capnometer/cannula combinations (oxygen at 4 l/min): (1) a mainstream capnometer with oral guide nasal cannula, (2) a sidestream capnometer with a nasal cannula that included an oral guide, and (3) a sidestream capnometer with a standard nasal cannula. Arterial carbon dioxide partial pressure was determined simultaneously. The major outcome was the arterial-to-end-tidal partial pressure difference with each combination. Results In non-obese patients, arterial-to-end-tidal pressure difference was 3.0 +/- 2.6 (mean +/- SD) mmHg with the mainstream capnometer, 4.9 +/- 2.3 mmHg with the sidestream capnometer and oral guide cannula, and 7.1 +/- 3.5 mmHg with the sidestream capnometer and a standard cannula (P &lt; 0.05). In obese non-OSA patients, it was 3.9 +/- 2.6 mmHg, 6.4 +/- 3.1 mmHg, and 8.1 +/- 5.0 mmHg, respectively (P &lt; 0.05). In obese OSA patients, it was 4.0 +/- 3.1 mmHg, 6.3 +/- 3.2 mmHg, and 8.3 +/- 4.6 mmHg, respectively (P &lt; 0.05). Conclusions Mainstream capnometry performed best, and an oral guide improved the performance of sidestream capnometry. Accuracy in non-obese and obese patients, with and without OSA, was similar.

scholarly journals Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

2020 ◽  
Author(s):  
Capan Konca ◽  
Mehmet Tekin ◽  
Fatih Uckardes ◽  
Samet Benli ◽  
Ahmet Kucuk
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Failure ◽  
Pediatric Patients ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mechanically Ventilated ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

AbstractIn the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

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