Cardiac Function and Hypercarbia

Rasmussen, Jens; Dauchot, Paul J.; DePalma, Ralph G.; Sørensen, B.; Regula, Gary A.; Anton, Aaron H.; Gravenstein, J. S.

doi:10.1001/archsurg.1978.01370220082013

Cited by 116 publications

(23 citation statements)

References 41 publications

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“…29–31 Acidosis suppresses myocardial function, causes pulmonary vasoconstriction, and might worsen right ventricular heart failure. 32 Sympathetic stimulation and increased afterload may represent a challenge to patients with borderline cardiac reserve. 33 PaCO 2 values appear to normalize ∼1 hour after the release of pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Harrison¹,

Smart²,

White³

et al. 2014

JSLS

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Background and Objectives:Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery.Methods:Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days).Results:Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] = 2.02; 95% confidence interval [CI], 1.05–3.90; P = .027), and blood loss of >500 mL (OR = 3.114; 95% CI, 1.501–6.462, P = .002).Conclusions:Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.

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Section: Discussionmentioning

confidence: 99%

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Harrison¹,

Smart²,

White³

et al. 2014

JSLS

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“…First, there are species differences with respect to the cardiovascular responses to hypercapnic acidosis. Acute hypercapnic acidosis causes increased HR and CO in dogs 5,25 and humans, 4 but decreases HR and CO in rabbits. Therefore, it may not be appropriate to simply extrapolate our results to humans.…”

Section: Discussionmentioning

confidence: 97%

Left ventricular contractility is reduced by hypercapnic acidosis and thoracolumbar epidural anesthesia in rabbits

Mizukoshi

Sato

Yoshida

2001

Can J Anesth/J Can Anesth

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Purpose: We have previously observed that sympathetic blockade by epidural anesthesia (EA) modifies the cardiovascular response to marked hypercapnic acidosis in dogs. Our objective was to determine whether the combination of marked hypercapnic acidosis and EA reduce left ventricular contractility.Methods: We randomly assigned 22 Japanese white rabbits anesthetized with isoflurane (1.0%) to two groups according to the absence (control group, n=11) or presence (EA group, n=11) of thoracolumbar EA. After epidural injection (0.5 mL·kg -1 of 0.9% saline in the control group or 1% mepivacaine in the EA group) and during subsequent hypercapnia (mean arterial CO 2 tension 85 mmHg), we measured left ventricular pressure, left ventricular volume by using conductance catheter and plasma catecholamine concentrations. Left ventricular contractility was assessed by the slope of the linear approximation of the left ventricular end-systolic pressure-volume relationship, [i.e., end-systolic elastance (Ees)].Results: The combination of hypercapnic acidosis and thoracolumbar EA caused a 65% decrease in Ees (P <0.05). Hypercapnic acidosis alone caused a 16% decrease (P <0.05) and thoracolumbar EA alone caused a 49% decrease in Ees (P <0.05). In the EA group, epidural injection caused an 85% decrease in the epinephrine concentration (P <0.05) and a 39% decrease in the norepinephrine concentration (P <0.05), even during hypercapnic acidosis. However, in the control group, hypercapnic acidosis caused no change in the circulating epinephrine concentration but a 74% increase in the circulating norepinephrine concentration (P <0.05).

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“…2 Since it is then a myocardial depressant and has direct vasodilator effect. In the study performed, no undue haemodynamic changes directly attributable to hypercarbia or acidosis were recorded and none of the patients required blood transfusion perioperatively.…”

Section: Discussionmentioning

confidence: 99%

Effects of Co2 Pneumoperitoneum on Arterial Partial Pressure of Carbon Dioxide Ph, End Tidal Carbon Dioxide and Bicarbonate in Patients During Laparoscopic Cholecystectomy

Hakeem¹,

Iqbal²,

Dawood³

et al. 2016

jemds

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AIMSLaparoscopically performed surgeries have increased manifold as they have provided many advantages when compared to traditional way of performing surgeries. But laparoscopic technique has its own disadvantages, which may be in form of metabolic effects of CO2 pneumoperitoneum. Current observation study was designed for observing metabolic changes in form of PaCO2, EtCO2, pH and bicarbonate levels in patients undergoing laparoscopic cholecystectomy and their effects on patient if any. Role of lung protective ventilation in managing PaCO2 and to ascertain the need of arterial blood gas monitoring in presence of EtCO2 monitoring in laparoscopic procedures like cholecystectomy. METHODS50 ASA 1 and ASA 11 patients undergoing laparoscopic cholecystectomy were selected for this study. Each of them was anaesthetised by standard protocol for general anaesthesia with endotracheal intubation. Surgical technique was uniform in all the cases. Arterial blood gas sampling was done prior to CO2 pneumoperitoneum and at intervals of 15 minutes and 30 minutes and then in recovery post reversal of pneumoperitoneum and extubation once patient was stable. Variables like PaCO2, EtCO2, pH and bicarbonate were recorded and analysed statistically for results. RESULTSThere were significant changes in PaCO2, EtCO2, pH and bicarbonate at 15 min and 30 min intervals with return to baseline in early post-operative period. Changes in variables were in normal range for these variables without any significant effect on patient. Furthermore, it was noted that EtCO2 varied in accordance to PaCO2, thus could be used as surrogate marker of PaCO2 in case of arterial blood gas measurement is not available. CONCLUSIONLaparoscopic cholecystectomy with CO2 pneumoperitoneum results in changes in PaCO2, EtCO2, pH and bicarbonate, but the changes return to baseline in early post-operative period on reversal of CO2 pneumoperitoneum. EtCO2 monitoring can be used as surrogate marker in short laparoscopic procedures in most cases in case arterial blood gas monitoring is not available. Lung protective ventilation could be used to manage PaCO2 intra-operatively.

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Cardiac Function and Hypercarbia

Cited by 116 publications

References 41 publications

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Left ventricular contractility is reduced by hypercapnic acidosis and thoracolumbar epidural anesthesia in rabbits

Effects of Co2 Pneumoperitoneum on Arterial Partial Pressure of Carbon Dioxide Ph, End Tidal Carbon Dioxide and Bicarbonate in Patients During Laparoscopic Cholecystectomy

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