Abstract
We studied the changes in end-tidal CO2 (ETCO 2) and systemic responses after tourniquet deflation in spontaneously breathing and ventilation-controlled patients during orthopedic surgery of both the upper and/or the lower extremities. In most patients, increases in ETCO 2, heart rate, and PaCO 2, as well as decreases in blood pressure and pH were observed. In every spontaneously breathing patient, the respiratory rate began to increase before the ETCO 2 reached a maximum. Arterial blood gas analysis suggested that the increase in ETCO 2 closely reflected the increase in PaCO 2. Our study yielded new information on the ETCO 2 changes as follows: 1) the time for ETCO 2 level to reach a peak (peak time) was almost constant despite the considerable differences in the increases in ETCO 2 both in spontaneous breathing and ventilation-controlled groups and the peak time in the former group was shorter than that in the latter group; and 2) it was suggested that the increase in ETCO 2 in the spontaneously breathing patients was smaller than that in ventilation-controlled patients when both patients were subjected to the same conditions on tourniquet time and tourniqueted area. Our data showed that the increase in ETCO 2 (or PaCO 2) can be large and prolonged in some situations. Thus, we recommend continuous ETCO 2 monitoring and the proper hyperventilation at tourniquet deflation in order to minimize any adverse effects of acidosis.
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Akata, T., Tominaga, M., Sagiyama, M. et al. Changes in end-tidal CO2 level following tourniquet deflation during orthopedic surgery. J Anesth 6, 9–16 (1992). https://doi.org/10.1007/s0054020060009
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DOI: https://doi.org/10.1007/s0054020060009