Gastric Mucosal End-Tidal Carbon Dioxide Partial Pressure Difference as a Continuous Indicator of Splanchnic Perfusion During Prolonged Anesthesia
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- Category: Vol. 81, June 2013
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Gastric Mucosal End-Tidal Carbon Dioxide Partial Pressure Difference as a Continuous Indicator of Splanchnic Perfusion During Prolonged Anesthesia,RAGAA A.A.M. HERDAN, ABDELRADY S. IBRAHIM, SAHAR A.M. EL-GAMMAL, MOHAMED ABDEL-MONEIM BAKR, MOHAMED MOHAMED ABDEL LATIF and HANY AHMED IBRAHEEM
Abstract
Aim of the Study: This study was designed to investigate the influence of prolonged anesthesia on gastric mucosal tonometric values compared to commonly measure global indices of splanchnic hypoperfusion.
Patients and Methods: 36 adult patients scheduled for elective prolonged microvascular surgeries with duration more than 5 hours under general anesthesia were allocated into three groups according to the duration of the prolonged surgery (12 in each): Group I: With duration of about 6 hr, group II: With duration of about 10 hr and group III: With duration of about 12 hr.
Measurement: Heart rate, mean arterial blood pressure, central venous pressure, end tidal carbon dioxide tension, ABG (pH, PaCO2 and paO2) and tonometric parameters including; gastric intra-luminal PCO2, the difference between gastric intra-luminal PCO2 (PgCO2) and end-tidal PCO2 (PgCO2-PetCO2) and gastric intra-mucosal pH (pHi) and Serum Lactate concentration. Measurements done after induc-tion of anesthesia (baseline) and every two hours from start of mechanical ventilation till the end of surgery.
Results: There were gradual significant increases (p<0.01) in the mean values of PgCO2 and gastric mucosal end tidal CO2 partial pressure difference through all subsequent readings in the three groups compared with the baseline value. There were gradual decrease in the mean values of gastric intra-mucosal pH over time and this decrease reaches its maximum value at 12 hours after induction of anesthesia in group III. The arterial lactate concentration mean values showed signif-icant increases (p<0.000) in group I, group II and group III at different study periods when compared to baseline value.
Conclusion: Prolonged general anesthesia produced GI hypoperfusion manifested by increased PgCO2, PgCO2-PetCO2 gap and decreased pHi despite maintaining 02 delivery.