Effects of hypercapnia versus normocapnia during general anesthesia on outcomes: a systematic review and meta-analysis

Petran, Jan; Ansems, Kelly; Rossaint, Rolf; Marx, Gernot; Kalvelage, Christina; Kopp, Rüdger; Benstoem, Carina; Brülls, Christian

doi:10.1016/j.bjane.2020.11.010

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…Therefore, further studies with a sufficient number of participants undergoing the same type of surgery are needed to investigate the incidence of PONV beyond this point. In addition, we did not compare the two groups for many factors that affect the occurrence of PONV, such as hypotension and hypercarbia [ 27 , 28 ]. Further, due to the different characteristics of the two anesthetics, double blinding was not possible for the anesthesiologist involved in anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

Kim

Yoon

et al. 2023

BMC Anesthesiol

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Background Remimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery. Methods Patients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery. Results The incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05). Conclusions In this study, remimazolam did not increase the incidence and severity of PONV compared with propofol. Trial registration KCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.

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Section: Discussionmentioning

confidence: 99%

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

Kim

Yoon

et al. 2023

BMC Anesthesiol

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“…To determine how the EtCO 2 level affects postoperative organ dysfunction, exposure was defined by calculating the dose, time, and cumulative effects of EtCO 2 . Dose effects were assessed using the mean EtCO 2 ; patients were divided into two groups based on the cutoff level of 35 mmHg, widely used lower limit of normal PaCO 2 [16,17]. We defined low EtCO 2 patients as those with a mean EtCO 2 of less than 35 mmHg, whereas we defined normal EtCO 2 patients as those with a mean EtCO 2 of more than or equal to 35 mmHg.…”

Section: Exposurementioning

confidence: 99%

Association between intraoperative end-tidal carbon dioxide and postoperative organ dysfunction in major abdominal surgery: A cohort study

et al. 2023

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Background Data on the effects of intraoperative end-tidal carbon dioxide (EtCO2) levels on postoperative organ dysfunction are limited. Thus, this study was designed to investigate the relationship between the intraoperative EtCO2 level and postoperative organ dysfunction in patients who underwent major abdominal surgery under general anesthesia. Methods We conducted a cohort study involving patients who underwent major abdominal surgery under general anesthesia at Kyoto University Hospital. We classified those with a mean EtCO2 of less than 35 mmHg as low EtCO2. The time effect was determined as the minutes when the EtCO2 value was below 35 mmHg, whereas the cumulative effect was evaluated by measuring the area below the 35-mmHg threshold. The outcome was postoperative organ dysfunction, defined as a composite of at least one organ dysfunction among acute renal injury, circulatory dysfunction, respiratory dysfunction, coagulation dysfunction, and liver dysfunction within 7 days after surgery. Results Of the 4,171 patients, 1,195 (28%) had low EtCO2, and 1,428 (34%) had postoperative organ dysfunction. An association was found between low EtCO2 and increased postoperative organ dysfunction (adjusted risk ratio, 1.11; 95% confidence interval [CI], 1.03–1.20; p = 0.006). Additionally, long-term exposure to EtCO2 values of less than 35 mmHg (≥224 min) was associated with postoperative organ dysfunction (adjusted risk ratio, 1.18; 95% CI, 1.06–1.32; p = 0.003) and low EtCO2 severity (area under the threshold) (adjusted risk ratio, 1.13; 95% CI, 1.02–1.26; p = 0.018). Conclusions Intraoperative low EtCO2 of below 35 mmHg was associated with increased postoperative organ dysfunction.

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“…At the tissue level, it causes rightward shift of oxyhemoglobin dissociation curve and enables O 2 offloading at lower O 2 tension (Bohr effect) [2]. As a result, mild hypercarbia improves oxygen delivery to tissue and healing process at the surgical site [41].…”

Section: Systemic Effect Of Elevated Comentioning

confidence: 99%

“…Stimulation of the chemoreceptors triggers increased minute ventilation, improved lung compliance, and small airway dilation [2]. Hypercarbia aids in weaning infants from mechanical ventilation and reduces time to extubation during emergence from anesthesia [41]. However, hypercarbia reduces skeletal muscle contractility.…”

Section: Systemic Effect Of Elevated Comentioning

confidence: 99%

Review of pediatric hypercarbia and intraoperative management

Evans

Dore

Couser

2022

Current Opinion in Anaesthesiology

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Purpose of reviewHypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO 2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO 2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. Recent findingsAlthough physiological range in this patient population may not be fully understood, it is known that any rapid change from a child's baseline increases risks of complications. Any derangements in CO 2 are further compromised by hypoxia, hypotension, hypothermia, anemia, all of which may occur in a dynamic operating room environment.

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Effects of hypercapnia versus normocapnia during general anesthesia on outcomes: a systematic review and meta-analysis

Cited by 4 publications

References 20 publications

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

Association between intraoperative end-tidal carbon dioxide and postoperative organ dysfunction in major abdominal surgery: A cohort study

Review of pediatric hypercarbia and intraoperative management

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