Zhou Q., Cao B., Niu L., Cui X., Yu H., Liu J., Li H., Li W. Effects of permissive hypercapnia on laparoscopic surgery for rectal carcinoma.
Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial. Huang D., Zhou S., Yu Z., Chen J., Xie H. Trendelenburg position hypercapnia lung-protective ventilation optic nerve sheath diameter pneumoperitoneum total intravenous anesthesia. In conclusion, mild hypercapnia during the LPV might not aggravate the increase in the ONSD during CO 2 pneumoperitoneum in the Trendelenburg position and could improve rSO 2 compared to normocapnia in patients undergoing gynecological laparoscopy with TIVA. Alveolar dead space was significantly higher in the normocapnia group than in the hypercapnia group at Tpp40 ( p = 0.001). The rSO 2 decreased significantly in the normocapnia group ( p = 0.01), whereas it increased significantly in the hypercapnia group at Tpp40 compared with Tind ( p = 0.002). There was a significant intergroup difference in changes over time in the rSO2 ( p < 0.001). The ONSD increased significantly at Tpp40 when compared to Tind in both normocapnia and hypercapnia groups ( p = 0.02 and 0.002, respectively). There was no significant intergroup difference in change over time in the ONSD ( p = 0.318). The ONSD, rSO 2, and respiratory and hemodynamic parameters were measured at 5 min after anesthetic induction (Tind) in the supine position, and at 10 min and 40 min after pneumoperitoneum (Tpp10 and Tpp40, respectively) in the Trendelenburg position. Patients under propofol/remifentanil total intravenous anesthesia were randomly assigned to either the normocapnia group (target PaCO 2 = 35 mmHg, n = 30) or the hypercapnia group (target PaCO 2 = 50 mmHg, n = 30). Sixty patients (aged between 19 and 65 years) scheduled for laparoscopic gynecological surgery in the Trendelenburg position.
The purpose of this study was to compare the effects of normocapnia and mild hypercapnia on the optic nerve sheath diameter (ONSD), regional cerebral oxygen saturation (rSO 2), and intraoperative respiratory mechanics in patients undergoing gynecological laparoscopy under total intravenous anesthesia (TIVA). Cerebral hemodynamics may be altered by hypercapnia during a lung-protective ventilation (LPV), CO 2 pneumoperitoneum, and Trendelenburg position during general anesthesia.
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