5 years ago

Quantitative analysis of the effect of end-tidal carbon dioxide on regional cerebral oxygen saturation in patients undergoing carotid endarterectomy under general anaesthesia

Seung-Hee Ki, Yong-Pil Cho, Gyu-Jeong Noh, Tae-Won Kwon, Jin-Ho Rhim, Byung-Moon Choi, Young-Jin Han, Jae-Hong Park
Aim Regional cerebral oxygen saturation (rSO2) is currently the most used measure in clinical practice to monitor cerebral ischemia in patients undergoing carotid endarterectomy (CEA). Although end-tidal carbon dioxide (PETCO2) is known as a factor that influences rSO2, the relationship between PETCO2 and rSO2 has not been quantitatively evaluated in patients with severe arteriosclerosis. This study aimed to evaluate the effect of PETCO2 on rSO2 in patients undergoing CEA under general anaesthesia. Methods The intervention to change PETCO2 was conducted between skin incision and clamping of the carotid artery. The rSO2 values were observed by changing PETCO2 in the range of 25-45 mmHg. The PETCO2–rSO2 relationship was characterized by population analysis using a turnover model. Results In total, 1,651 rSO2 data points from 30 patients were used to determine the pharmacodynamic characteristics. Hypertension (HTN) and systolic blood pressure (SBP) were significant covariates on the slope factor in the stimulatory effect of PETCO2 on rSO2 and fractional turnover rate constant (kout), respectively. The estimates of the parameters were kout(min-1): 3.59 for SBP < 90 mmHg and 0.491 for SBP ≥ 90 mmHg, slope: 0.00321 for patients with HTN and 0.00664 for patients without HTN. Conclusion The presence of hypertension attenuates the response of rSO2 after a change in PETCO2. When cerebral blood flow is in a state of decline caused by a decrease in SBP to less than 90 mmHg, the response of rSO2 to PETCO2 is increased. It is advisable to maintain SBP above 90 mmHg in patients with hypertension during CEA.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bcp.13441

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