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Suzanna Miller
5 years ago
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1 The effects of blood pressure variations on end-tidal and arterial CO 2 pressure differences in patients undergoing coronary artery bypass graft Alireza Mahoori, MD Ebrahim Hasani, MD Hamid Mehdizadeh, MD Nader Nanbakhsh, MD ABSTRACT Introduction: Capnography, the measurement of CO 2 in respiratory gases has become an integral part of anaesthesia monitoring. A decrease in end tidal CO 2 is seen with a decrease in blood pressure and cardiac output if ventilation remains constant. The aim of this study was to prospectively assess the effect of changes in the blood pressure (20% above or below from baseline) on arterial-to-end tidal carbon dioxide gradient [P(a-ET)CO 2 ] and their relationship during general anesthesia for coronary artery bypass graft surgery. Materials and methods: Fifty patients undergoing coronary artery bypass graft surgery were selected. A standard anaesthetic procedure was followed for all cases. Systoloic and diastolic arterial blood pressure were recorded as baseline after induction of general anesthesia, 20% above or below from baseline was calculated in all patients. The end tidal (ET) CO 2 and PaCO 2 were recorded at basline arterial blood pressure and during 20% above or below from baseline. Results: A significant increase in P(a-ET)CO 2 was noted from 20% above of baseline and baseline to 20% below of baseline. (4.1±3.3 vs. 6.4±4.7 vs. 7±3 respectively).the Pearson correlation coefficient was 0.5, 0.4 and 0.5 respectively. There was a significant correlation between PaCO 2 andetco 2 in each of the three conditions. (p<0.001) Conclusion: In conclusion, the clinical practice of predicting PaCO 2 from ETCO 2 must be tempered by recognition of the potential magnitude of P(a-ET) CO 2 gradient, which is higher than normal during hypotension. Further investigations are recommended. Keywords: Blood Pressure, carbon dioxide/blood, capnography.! " #$" % &'!()!" * #!+, 1!" #$!% ١ ar_mahoori@yahoo.com/.

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7 REFERENCES 1. Takano Y, Sakamoto O, Kiyofuji C, Ito K. A comparison of the end tidal CO 2 measured by portable capnometer and the arterial PCO2 in spontaneously breathing patients. Respir Med. 2003; 97(5): Eskaros SM, Papadakos PJ, Lachmann B. Respiratory Monitoring. In: Miller RD editor. Miller's Anesthesia. Philadelphia, Churchill Livingstone, 2010, Yosefy C, Hav E, Nasri Y, Magen E, Reisin L. End tidal carbon dioxide as a predictor of the arterial PCO 2 in the emergency department setting. Emerg Med J. 2004; 21(5): Paul L. Marino. The IcuBool. Oxygen and carbon dioxide transport. 3ed.Philadelphia; 2007; Ronald D. Miller. Miller's Anesthesia. Nancy A. Nussmeier, Michael C. Hauser, Muhammal F. Sar war, ALina M. Crigove, and Bruce E. Searles. Anesthesia For cardiac. Surgical procedures. 7ed. Churchil Livingstone; Syed Shujat A, Alexander Dubikaitis, Abdul Raheem al Gattan. The relationship between end tidal carboon dioxide and urterial carbon dioxide during controlled hypotensice anesthesia. Med principles pact 2002; 11: Shibutani K, Muraoka M, Shirasaki S, Kubal K, Sanchala VT, Gupte P. Do changes in end Tidal PCO2 Quantitatively reflect changes in cardiaout put? AnesthAnalg 1994; 79: DMello J, Butani M. Capnography. Indian J Anesth. 2002; 46(4): Casati A. Salvo I, Torri G, Calderini E. Arterial to end- tidal carbon dioxide gradient and physiological deal space monitoring during general anesthesia; effects of patient's position. Minerva Anestesial 1997; 63(6): Moon SW, Lee SW, Choi SH, Hong YS, Kim SJ, Kim NH. Arterial minus endtidalco2 as a prognostic factor of hospital survival in patients resuscitated from cardiac arrest. Resuscitation 2007, 72(2): Kheng CP, Rahman NH. The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department. Int J Emerg Med. 2012, 24;5(1):31. doi: / Gazmuri R, Kube E. Capnography during cardiac resuscitation: a clue on mechanisms and a guide to interventions. Crit Care 2003, 7(6): '**+ A c n >= &,% (UB%6- (UB%.6 >@ $ (Rv 59 M9"... 8*+ (X6%,% 1+ '.+, ' + = (11). K %B" '*% 1- & 1+ '.+, + ' T),- <ABC 8 % &,%.(12) 8$* '.+, 4-5=0 (K 8ABC 5-* ABC 1-. E &,% 1+, >-) >@ $ 5$ 1 %9. 3%.% u 96S &,% - 1+ '.+ % 'A",% 8ABC '-.3u=.' '% 1+ '.+, $ >-) a <ABC - & "K %20 $ &,% (' + $ C *A DZ%@, - & "1- %20 9 > 5$ >E m9" >@ $ 5$ *- ' &,% 1+ '.+, zc <CV B 56 B9 ^ wa $ n + 1- *A- {56P+ Bd. 1+ '.+, 1 M9" 1-% >" - >@ 1+ '.+, $ &,% & >' Q Nf6 1- {E 56 8Z 5 + <ABC,05-'S >@ $ 3%."= 9 U=.- >= ABC P '-.3*+,%6 >= j=..) tvs Bd. 1- "3B6 >=, 1+ '.+, $ >-) >@ $ 4-$ '0! 40+ C@ 8; & - U-vB-$ 5* %5 " 3 5 5$- '.+, >-) (>@ $ 4-$ 8;.+ '0!,F" &,% '*-E ABC, 0 #$ <Bd..'

(5) CORRELATION OF END TIDAL CARBON DIOXIDE WITH ARTERIAL CARBON DIOXIDE DURING CARDIOPULMONARY BYPASS.

(5) CORRELATION OF END TIDAL CARBON DIOXIDE WITH ARTERIAL CARBON DIOXIDE DURING CARDIOPULMONARY BYPASS. Dr. J. V. Kothari 1, Dr. R. D. Patel 2, Dr. A. Chaurasiya 3, Mr. Atul Solanki 4, Dr. R. M. Thosani