Permissive hypercapnia: Is there any upper limit?

Garg, Sunil Kumar

doi:10.4103/0972-5229.140154

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…We read the article by Garg SK “Permissive hypercapnia: Is there any upper limit?”[ 1 ] with great interest. The author has rightly focused on a current protective lung ventilation strategy.…”

mentioning

confidence: 99%

Permissive hypercapnia: Is there any upper limit?

Nayak¹,

Jindal²

2015

Indian Journal of Critical Care Medicine

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confidence: 99%

Permissive hypercapnia: Is there any upper limit?

Nayak¹,

Jindal²

2015

Indian Journal of Critical Care Medicine

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“…Garg et al considered that when oxygenation and circumfusion are sufficient, permissible hypercapnia (PHV) allows a maximum PaCO 2 of 67 mmHg and a minimum pH of 7.2 in arterial blood gas. 9) According to previous research, carbon dioxide artificial pneumothorax under low pressure (<8 mmHg) has no significant effect on respiration and circulation. 10) In our study, after 8 mmHg CO 2 insufflation, arterial blood gas analysis, and ventilator parameters indicated a decrease in pH and an increase in PetCO 2 and PaCO 2 , suggesting acidosis and hypercapnia within acceptable levels.…”

Section: Discussionmentioning

confidence: 96%

Application of Right Bronchial Occlusion under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive McKeown Esophagectomy

Zhao

Han

2021

ATCS

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Purpose: To evaluate the feasibility and safety of single-lumen endotracheal intubation combined with right bronchial occlusion (SLET) under artificial pneumothorax in minimally invasive McKeown esophagectomy. Methods: A total of 165 patients who underwent minimally invasive McKeown esophagectomy at Peking Union Medical College Hospital were retrospectively analyzed. In all, 48 patients received double-lumen endotracheal intubation (DLET group), and 117 patients received SLET-B (SLET-B group). Clinical data, intraoperative hemodynamics, surgical variables, and postoperative complications were analyzed and compared. Results: Compared with the DLET group, a shorter intubation time and lower tube dislocation rate were found in the SLET-B group. In the thoracic phase, with the application of artificial pneumothorax, patients in the SLET-B group had lower partial pressure of carbon dioxide (PaCO 2 ) and end-tidal carbon dioxide pressure (PetCO 2 ) values and higher pH than those in the DLET group. Patients in the SLET-B group had shorter thoracic phase times and hospital stays and less intraoperative hemorrhage than those in the DLET group. The numbers of thoracic and bilateral recurrent laryngeal lymph nodes harvested were significantly higher in the SLET-B group. Conclusion: SLET under artificial pneumothorax is feasible and safe in minimally invasive McKeown esophagectomy.

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“…In current practice, mean maximum PaCO 2 and pH associated with permissive hypercapnia are around 67 mmHg and 7.2, respectively, ( 24 ). It was reported that hypercapnia can be well tolerated as long as tissue perfusion and oxygenation are preserved and there are no contraindications ( 25 ). But hypercapnia may cause cardiovascular and cerebrovascular problems and acid-base imbalance.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of stress and spontaneous respiration: Efficacy and safety of monitored anesthesia care by target-controlled infusion remifentanil in combination with dexmedetomidine in fibreoptic bronchoscopy for patients with severe tracheal stenosis

Zhou

Zhu

et al. 2022

Front. Med.

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ObjectiveThis study aimed to determine the effective concentration of target-controlled infusion (TCI) of remifentanil used to inhibit stress during the treatment of severe tracheal stenosis with fibreoptic bronchoscopy and to evaluate the monitored anesthesia care (MAC) by remifentanil.Materials and methods60 patients with severe tracheal stenosis who underwent fibreoptic bronchoscopy was performed. Dexmedetomidine was initially administered at a bolus dose (0.8 mcg/kg), followed by a 0.5 mcg/(kg⋅h) continuous infusion. Remifentanil was administered by TCI. The effective concentration (EC) of remifentanil was titrated by the improved sequential method, and 30 patients were included. The EC95 of remifentanil was set as the plasma target concentration to evaluate the safety of the MAC, and another 30 patients were included.ResultsThe half effective effect-chamber concentration of remifentanil (EC50) was 2.243 ng/ml, and the EC95 was 2.710 ng/ml. Among the 30 patients who received an EC95 of remifentanil as the target concentration, one patient was remedied by injecting propofol, the score of Ramsay sedation was three. The incidence of subclinical hypoxemia (SPO2 of 90–95%) was 30%, the incidence of moderate hypoxemia (SPO2 of 75–89%, ≤60 s) was 20 and 86.7% of patients with oxygen saturation was less than 95% returned to normal by awakening. The satisfaction score of the operator was nine, the satisfaction score of the anesthesiologist was eight, the satisfaction score of the patients was 10, the rate of patient willingness to re-accept the procedure was 93.3% and the circulation was stable during the operation.ConclusionMAC using TCI of remifentanil with continuous pumping dexmedetomidine can effectively inhibit the stress response to fibreoptic bronchoscopy in patients with severe tracheal stenosis while maintaining spontaneous breathing. Under the anesthesia management of an experienced anesthesiologist, it provides a reference to tracheoscopic anesthesia of autonomous breathing.Clinical trial registration[http://www.chictr.org.cn/], identifier [ChiCTR 2100043380].

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Permissive hypercapnia: Is there any upper limit?

Cited by 8 publications

References 11 publications

Permissive hypercapnia: Is there any upper limit?

Permissive hypercapnia: Is there any upper limit?

Application of Right Bronchial Occlusion under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive McKeown Esophagectomy

Inhibition of stress and spontaneous respiration: Efficacy and safety of monitored anesthesia care by target-controlled infusion remifentanil in combination with dexmedetomidine in fibreoptic bronchoscopy for patients with severe tracheal stenosis

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