Isert P
Department of Anaesthesia & Intensive Care, Prince of Wales Hospital, Randwick, N.S.W.
Anaesth Intensive Care. 1994 Aug;22(4):435-41. doi: 10.1177/0310057X9402200419.
With the widespread availability of capnography, many anaesthetists have swung away from formally verifying hypocapnia by intraoperative arterial blood gas analysis and, instead, have come to rely upon capnography as an acceptable and constant predictor of arterial CO2 tension (PaCO2) during neurosurgery. However, the nature of the arterial-end-tidal CO2 gradient is complex, and is frequently unexpectedly large, or even negative. The importance of close intraoperative CO2 control during neurosurgery--more specifically, routine hyperventilation, and our reliance upon capnography to guide intraoperative management--is reappraised. There is a growing appreciation of the adverse effects of hyperventilation and hypocarbia, especially upon abnormal or ischaemic brain, and it is clear that capnography alone cannot be used to confidently predict the true PaCO2 during neuroanaesthesia.
随着二氧化碳监测技术的广泛应用，许多麻醉医生不再通过术中动脉血气分析来正式验证低碳酸血症，而是开始依赖二氧化碳监测技术，将其作为神经外科手术期间动脉血二氧化碳分压（PaCO2）的可接受且恒定的预测指标。然而，动脉-呼气末二氧化碳梯度的性质很复杂，且常常出乎意料地大，甚至为负。本文重新评估了神经外科手术期间严格控制术中二氧化碳水平的重要性——更具体地说，是常规过度通气以及我们依靠二氧化碳监测技术来指导术中管理的情况。人们越来越认识到过度通气和低碳酸血症的不良影响，尤其是对异常或缺血性脑的影响，而且很明显，仅靠二氧化碳监测技术不能可靠地预测神经麻醉期间的真实PaCO2。
