Carbon dioxide dynamics during apneic oxygenation: the effects of preceding hypocapnia.

STUDY OBJECTIVE

To compare the rate of increase of arterial carbon dioxide tension (PaCO2) during apneic oxygenation preceded by acute respiratory hypocapnia with that during apnea preceded by respiratory eucapnia.

DESIGN

Randomized, prospective, single crossover study.

SETTING

Operating room at a teaching hospital.

PATIENTS

19 ASA physical status I, II, and III patients requiring general endotracheal anesthesia and invasive monitoring for elective surgery.

INTERVENTIONS

Two ventilatory states preceding apneic oxygenation were studied in each patient. The first respiratory state was established using controlled mechanical ventilation in the stable, anesthetized patient, followed by a 5-minute period of apneic oxygenation. Arterial and mixed central venous blood gas samples were obtained simultaneously prior to and at 1-minute intervals during apnea. Ventilatory parameters were then changed to establish the second respiratory state. During the subsequent period of apnea, the study was repeated as above.

MEASUREMENTS AND MAIN RESULTS

Arterial and mixed central venous partial pressure of carbon dioxide (pCO2) levels were measured. A greater increase in PaCO2 was found during the first minute of apneic oxygenation in the hypocapneic group compared with the eucapneic group. The venoarterial gradient of pCO2 was also greater in the hypocapneic group prior to apnea.

CONCLUSIONS

Acute hypocapnia compared with eucapnia prior to apneic oxygenation is associated with a greater rise in PaCO2 in the anesthetized patient. This finding may be due in part to widening of the venoarterial gradient of pCO2.