Arterial to end-tidal carbon dioxide pressure gradient increases with age in the steep Trendelenburg position with pneumoperitoneum.
10.4097/kjae.2012.63.3.209
- Author:
Dae Kee CHOI
1
;
In Gyu LEE
;
Jai Hyun HWANG
Author Information
1. Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea. jhhwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Age;
Carbon dioxide;
Pneumoperitoneum;
Trendelenburg position
- MeSH:
Aged;
Anesthesia;
Anesthesia, General;
Arterial Pressure;
Carbon;
Carbon Dioxide;
Head-Down Tilt;
Heart Rate;
Humans;
Intubation;
Linear Models;
Lung Compliance;
Pneumoperitoneum;
Prostatectomy;
Supine Position;
Ventilation
- From:Korean Journal of Anesthesiology
2012;63(3):209-215
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Several factors affect the end-tidal carbon dioxide pressure (PETCO2) and increase the arterial to end-tidal carbon dioxide pressure gradient (Pa-ETCO2) during general anesthesia. We evaluated the relationship between age and Pa-ETCO2 during pneumoperitoneum in the steep Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). METHODS: Ninety-two consecutive patients undergoing RALP were divided by age into a middle-aged (45-65 years) and an elderly (> 65 years) group. Anesthesia was standardized. Heart rate, mean arterial pressure, peak inspiratory pressure, lung compliance, minute ventilation, PaO2, PETCO2, PaCO2, and Pa-ETCO2 were measured 10 min after intubation in the supine position without pneumoperitoneum (T0); and 10 (T1), 60 (T2), and 120 (T3) min after pneumoperitoneum in the Trendelenburg position. RESULTS: Although PETCO2 did not change significantly during surgery, PaCO2 and Pa-ETCO2 increased gradually with time during pneumoperitoneum in the Trendelenburg position, and both parameters showed greater increases in the elderly than in the middle-aged group. Simple linear regression analyses revealed significant correlations between age and Pa-ETCO2 at T0 (P = 0.018), T1 (P = 0.006), T2 (P < 0.001), and T3 (P = 0.001). Linear mixed model analysis showed that Pa-ETCO2 was associated statistically significantly with age and duration of pneumoperitoneum in the Trendelenburg position, but age and duration of pneumoperitoneum in the Trendelenburg position were not associated (P = 0.090). CONCLUSIONS: The magnitude of Pa-ETCO2 during pneumoperitoneum in the steep Trendelenburg position increased with age, which could be attributed to age-related respiratory physiological changes.
