Abstract
Transcutaneous oxygen tension (PiCO2) was measured in 30 patients scheduled for elective pulmonary resection requiring one-lung ventilation during anaesthesia. Simultaneous PtcO2 and arterial oxygen tension (PaO2) measurements were taken preoperatively (preop), intraoperatively during two-lung endotracheal (ET) and one-lung endobronchial ventilation (EB), and postoperatively (postop). There was a significant correlation (r) between PtcO2 and PaO2 at all time periods: 0.97 (preop); 0.91 (ET); 0.83 (EB);0.8I (postop). There were no significant differences among the transcutaneous oxygen indices (tcO2 index = PtcO2 IPaO2) in the preop (0.69 ± 0.09), ET (0.68 ± 0.10) andpostop (0.71 ± 0.12) time period. The tcO2 index was significantly lower during one-lung anaesthesia (0.61 ± 0.14). The PtcO2 was consistently lower than the corresponding PaO2 measurement, thus providing a continuous estimation of the“minimum” PaO2 level throughout anaesthesia and recovery. In four patients a marked drop in PtcO2 occurred just after the initiation of one-lung ventilation. In three, this was associated with arterial hypoxaemia and in one, haemo-dynamic compromise. In all four cases the PtcO2 was the first monitored parameter to change. As there is a substantial risk of developing hypoxaemia during thoracic anaesthesia, PtcO2 monitoring provides valuable early warning of impending hypoxaemia or haemodynamic compromise, thereby facilitating early therapeutic intervention.
Résumé
La tension d’oxygène transcutanée (PtcU2) était mesurée chez 30 patients cédulés pour résection pulmonaire élective requérant une ventilation d’un seul poumon durant l’anesthésie. La mesure simultanée de la PtcO2 et de la tension artérielle d’oxygène fPaO2) étaient faites en préopératoire (prêop), peropératoire durant la ventilation des deux poumons par tube endotrachêal (ET) et lors de la ventilation endobronchique a” un seul poumon (EB), ainsi qu’en période postopératoire (postop). lly avait une corrélation significative (r) entre la PtcO2 et la PaO2 à tous les temps étudiés: 0.97 (préop); 0.91 (ET); 0.83 (EB); 0.81 (postop). Il n’y avait aucune différence significative entre les indices transcutanés d’oxygène (tcO2 index = PtcO2IPaO2) dans la période préopératoire (0.69 ± 0.09). ET (0.68 ± 0.10) et postop (0.71 ± 0.12). L’index tcO2 était significativement plus bas lors de l’anesthésie avec un poumon unique (0.61 ± 0.14). La PtcO2 était constamment plus basse que la mesure correspondante du PaO2, fournissant ainsi une estimation continue de la valeur minimale de la PaO2 à travers l’anesthésie et le réveil. Chez quatre patients une diminution marquée de la PtcO2 est survenue juste après le début de la ventilation à un seul poumon. Chez trois de ces patients, ceci fut associé avec une hypoxémie artérielle tandis que dans l’ature elle s’est accompagnée d’un état hémodynamique compromis. Pour chacun, de ces quatre patients la PtcO2 était le premier paramètre surveillé à accuser des changements. Etant donné qu’il y a un risque substantiel de développer de l’hypoxémie lors de l’anesthésie thoracique, la surveillance de la PtcO2 fournit un indice précieux d’avertissement contre l’hypoxémie ou l’état hémodynamique compromis facilitant ainsi une intervention thérapeutique précoce.
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Chubra-Smith, N.M., Grant, R.P. & Jenkins, L.C. Perioperative transcutaneous oxygen monitoring in thoracic anaesthesia. Can Anaesth Soc J 33, 745–753 (1986). https://doi.org/10.1007/BF03027125
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DOI: https://doi.org/10.1007/BF03027125