medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2000, Number 3

<< Back Next >>

An Med Asoc Med Hosp ABC 2000; 45 (3)

Non invasive monitoring of oxygen consumption during total intravenous anesthesia

Fernández DPL, Rodríguez PMV, González VMA Álvarez GR, Horta BI, Genovés GH, CZambada ZC

Language: Spanish
References: 42
Page: 122-127
PDF size: 125.11 Kb.


ABSTRACT

Oxygen consumption (VO2) can be measured by a non invasive way (ni) during total anesthesia by means of a gas analyzer. Some experimental studies have demonstrated that anesthetics influence the VO2 of the whole organism. When surgery takes place under total anesthesia there is an increment in oxygen demand. The objective of this study is to observe how VO2 (ni) behaves under intravenous total anesthesia, how changes in oxygen consumption can be immediately detected establishing the relation with other parameters of anesthetic depth. Forty patients ASA I-II were included, with total endovenous anesthesia using propofol, fentanyl, both with a regime of infusion and cisatracurio, with a FiO2 of 68%. Median blood pressure and cardiac frequency (FC) were compared during the various surgical procedures. Respiratory gases interchange was measured with a gas analyzer (DATEX-OHMEDA AS/3), during 60 minutes and in 40 patients submitted to different surgical procedures (laparotomies, rinoseptoplasties, artroscopies) under total endovenous anesthesia with propofol, fentanyl and cisatracurio. An important correlation among VO2, PAM and FC variations was observed. This resulted to be statistically significant during induction (-0,662 with an R2 = 0,3865) during some times of the transoperative period and during emersion (+0,559, R2 = 0,3128. Monitoring non invasive gase interchange can provide an additional method to monitoring during anesthesia and in the evaluation of anesthesia depth level.


REFERENCES

  1. 1 Dejours P. Oxygen demand and gas exchange. In: Wood SC, Lefant C (eds). Evolution of respiratory processes lung biology in health and disease. Vol 13. New York: Marcel Dekker, 1979; 1-44.

  2. 2 Brenner C, Ahdout J, Finegan R. Transporte de oxígeno hacia los tejidos: Desde el pulmón hacia la mitocondria. En: Cuidados intensivos. Temas actuales 1/1991. México: Interamericana McGraw-Hill. Health Care Group, 1991; 19-33.

  3. 3 Cone JB. Vigilancia del oxígeno tisular. En: Cuidados intensivos. Temas actuales 1/1991. México: Interamericana McGraw-Hill. Health Care Group, 1991; 35-41.

  4. 4 Ducey J.B. Vigilancia del oxígeno durante la anestesia. En: Cuidados intensivos. Temas actuales 1/1991. México: Interamericana McGraw-Hill. Health Care Group, 1991; 97-106.

  5. 5 Kanwal JS. The stress response to surgical trauma: from physiological basis to therapeutic implications. Progress in Food and Nutrition Science 1986; 10: 67-132.

  6. 6 Prys-Roberts C, Greene LT. Studies of anaesthesia in relation to hypertension. II Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971; 43: 531-547.

  7. 7 Stoelting RK. Attenuation of blood pressure response to laryngoscopy and intubation with sodium nitroprusside. Anesth Analg 1979; 58: 116-119.

  8. 8 Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerin attenuates the pressure response to laryngoscopy and intubation of the trachea. Br J Anaesth 1983; 52: 145-153.

  9. 9 Fassoulaki A, Kaniaris P. Does atropine premedication affect the cardiovascular response to laryngoscopy and intubation? Br J Anesth 1982; 54: 1065-1069.

  10. 10 Fassoulaki et al. Metabolic responses -(VO2,VCO2 and energy expenditure)- Associated with nasal intubation of the trachea. Anesth Analg 1989; 68: 112-115.

  11. 11 Nunn JF. Applied respiratory physiology. 3rd ed. London: Butterworths, 1987: 211-230.

  12. 12 Viale JP, Annat G, Bertrand O, Thouverez B, Hoen JP, Motin J. Continuous measurement of pulmonary gas exchange during general anaesthesia in man. Acta Anaesthesiol Scand 1988; 32: 691-697.

  13. 13 Schumacker PT, Cain SM. The concept of a critical oxygen delivery. Intensive Care Medicine 1987; 13: 223-229.

  14. 14 Lind L. Metabolic gas exchange during different surgical procedures. Anaesthesia 1995; 50: 304-307.

  15. 15 Lind L. Metabolic gas exchange during gynaecological laparotomy and laparoscopy. Can J Anaesth 1994; 41 (1): 19-22.

  16. 16 Svensson KL, Henriksson BA, Sonander HG, Stenqvist O. Metabolic gas exchange during aortocoronary bypass surgery using a double pump system and mechanical ventilation. Acta Anaesthesiol Scand 1991; 35: 185-189.

  17. 17 Svensson KL, Sonander HG, Stenqvist O. Validation of a system for measurement of metabolic gas exchange during anaesthesia with controlled ventilation in an oxygen consuming lung model. Br J Anaest 1990; 64: 311-319.

  18. 18 Noe FE, Whitty AJ, Davies KR, Wickham BL. Noninvasive measurement of pulmonary gas exchange during general anesthesia. Anesth Analg 1980; 59 (4): 263-269.

  19. 19 Aukburg SJ, Geer RT, Wollman H, Neufeld GR. Errors in measurement of oxygen uptake due to anesthetic gases. Anesthesiology 1995; 62: 54-59.

  20. 20 Smithies MN, Royston B, Makita K, Konieczko K, Nunn JF. Comparison of oxygen consumption measurements: Indirect calorimetry versus the reversed Fick method. Critical Care Medicine 1988; 19 (11): 89-99.

  21. 21 Nunn JF, Makita K, Royston B. Validation of oxygen consumption measurements during artificial ventilation. American Physiological Society 1989: 98-123.

  22. 22 Lum L, Salville A, Shekhar V. Accuracy of physiologic dead space measurement in intubated pediatric patients using a metabolic monitor: Comparison with the Douglas bag method. Critical Care Medicine 1988; 26 (4): 57-72.

  23. 23 Meriläinen PT. Metabolic monitor. Internat J Clin Monitoring and Computing 1987; 4: 167-177.

  24. 24 Weissman C, Sardar A, Kemper M. In vitro evaluation of a compact metabolic measurement instrument. J Parenteral Entereral Nutrition 1990; 2: 216-221.

  25. 25 Tissot S, Delafosse B, Bertrand O, Bouffard Y, Viale JP, Annat G. Clinical validation of the Deltatrac monitoring system in mechanically ventilated patients. Intensive Care Medicine 1995; 21: 149-153.

  26. 26 Sheeren TW, Krossa M, Meriläinen P. Error in measurement of oxygen and carbon dioxide concentrations by the Deltatrac II metabolic monitor in the presence of desflurane. Br J Anaest 1998; April: 142-149.

  27. 27 Lindahl SGE. Oxygen consumption and carbon dioxide elimination in infants and children during anesthesia and surgery. Br J Anaest 1989, 62: 70-76.

  28. 28 Braun U et al. Evaluation of methods for indirect calorimetry with a ventilated lung model. Intensive Care Medicine 1989; 15: 196-202.

  29. 29 ATLS: Manual del curso avanzado de apoyo vital en trauma. Colegio Americano de Cirujanos, 1994; 55-59.

  30. 30 Henderson AM, Mosse CA, Forrester PC, Halsall D, Armstrong RF. A system for the continuous measurement of oxygen uptake and carbon dioxide output in artificially ventilated patients. Br J Anaest 1983; 55: 701-706.

  31. 31 Hedenstierna G. Gas exchange during anaesthesia. Br J Anaest 1990; 64; 507-514.

  32. 32 Lindahl SGE, Hulse MG, Hatch DJ. Ventilation and gas exchange during anaesthesia and surgery in spontaneously breathing infants and children. Br J Anaest 1984; 56: 121-124.

  33. 33 Torres GE. Insuficiencia respiratoria. Respiración normal e insuficiencia respiratoria. 2da ed. Cap 1. México: Ediciones Científicas La Prensa, 1991; 1-19.

  34. 34 Torres GE. Insuficiencia respiratoria. Clasificaciones epidemiológicas de la insuficiencia respiratoria. 2da ed. Cap 2. México: Ediciones Científicas La Prensa, 1991; 10-35.

  35. 35 Breen P. Respiración en anestesia: Fisiopatología y actualización clínica. Clin Norteam Anestesiol 1998; 1: 23-28.

  36. 36 Benumof. Respiración en anestesia: Fisiopatología y actualización clínica. Clin Norteam Anestesiol 1998; 1: 31-32.

  37. 37 Wycoff CC. Endotracheal intubation: Effects on blood pressure and heart rate. Anesthesiology 1960; 21: 153-8.

  38. 38 Wolf YG, Cotev, Perel. Dependence of oxygen consumption on cardiac output in sepsis. Critical Care Medicine 1989; 15 (39): 198-203.

  39. 39 Snyder JV, Pinsky MR (eds). Oxygen transport in the critically ill. Chicago, London: Year Book Medical Publishers, 1998: 211-217.

  40. 40 Ramanathan Sivam, Chalon Jack, Satyanarayana Tangatur, Arismendy James, Turndorf Herman. Continuous and simultaneous on-line measurements of VO2 and VCO2 during endotracheal anesthesia. Anesth Analg 1982; 61 (4): 362-365.

  41. 41 Zambada Z, Seguí V, Holler, Horta B, Genovés H. Monitorización metabólica durante el postoperatorio. Rev Asoc Mex Med Crit Ter Inten 1998; 12 (4): 136-140.

  42. 42 Shoemaker W et al. Intraoperative evaluation of tissue perfusion in high-risk patients by invasive and noninvasive hemodynamic monitoring. Crit Care Med 1999; 27 (10): 2147-2152.




2020     |     www.medigraphic.com