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  • Title: The effect of increased apparatus dead space and tidal volumes on carbon dioxide elimination and oxygen saturations in a low-flow anesthesia system.
    Author: Enekvist BJ, Luttropp HH, Johansson A.
    Journal: J Clin Anesth; 2008 May; 20(3):170-4. PubMed ID: 18502358.
    Abstract:
    STUDY OBJECTIVE: To determine if a large tidal volume (VT), with an unchanged end-tidal carbon dioxide partial pressure (PETco2), could improve arterial carbon dioxide elimination, oxygen saturation (Spo2), and arterial blood oxygenation. DESIGN: Prospective, randomized, clinical study. SETTING: Single university hospital. PATIENTS: 60 ASA physical status I and II patients scheduled for elective urologic or general surgery. INTERVENTIONS: Patients were randomly assigned to one of two treatments: patients in group 1, nondead space (NDS), received a fresh gas flow of 1 L/min without added apparatus dead space volume. Patients in group 2, dead space (DS), received ventilation using an added dead space volume between the Y-piece and tracheal tube. In both groups, patients' lungs were ventilated to a fixed PETco2 value of 33.8 mmHg. Patients in the DS group were ventilated with VTs to maintain an airway plateau pressure (Pplateau) of 0.04 cm H2O/kg over initial plateau pressure. The corrugated tube was then adjusted to maintain a fixed PETco2. MEASUREMENTS: Dead space volumes, PETco2, arterial CO2 tension (Paco2), SpO2, arterial O2 tension (Pao2), VTs, and airway pressures were measured. MAIN RESULTS: Arterial CO2 tension was significantly lower in the DS group, 36 +/- 2.3 mmHg, compared with the NDS group, 37.5 +/- 2.3 mmHg (P < 0.05), and the difference between PETco2 and Paco2 was lower in the DS group than in the NDS group (P < 0.001). Oxygen saturation was 99% +/- 1.0% in the DS group compared with 98.5% +/- 1.5% in the NDS group (P < 0.05). Arterial O2 tension was 13.2 +/- 25.5 mmHg in the DS group and 119.1 +/- 30.2 mmHg in NDS group (not significant). CONCLUSION: Larger VTs, with an unchanged PETCO2 concentration created by an added apparatus dead space volume, improved arterial carbon dioxide elimination.
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