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  • Title: Are pulse oximetry and end-tidal carbon dioxide tension monitoring reliable during laparoscopic surgery?
    Author: Nyarwaya JB, Mazoit JX, Samii K.
    Journal: Anaesthesia; 1994 Sep; 49(9):775-8. PubMed ID: 7978132.
    Abstract:
    Cardiorespiratory changes induced by pneumoperitoneum and head-up tilt may generate alveolar ventilation to perfusion ratio changes and increased systemic vascular resistances. The reliability of end-tidal carbon dioxide tension and pulse oximetry in predicting arterial carbon dioxide partial pressure and arterial oxygen saturation may therefore be affected. The 35 ASA 1-2 patients in this study comprised 12 men and 23 women aged 48 (SD 17) years and weighing 71 (SD 14) kg. Twenty-nine were to undergo upper abdominal laparoscopy for cholecystectomy and six hyperselective vagotomy. Intra-abdominal pressure was 1.7 (SD 0.9) kPa and head-up tilt was 5.6 (SD 4.2) degrees. After abdominal insuflation, arterial carbon dioxide partial pressure significantly increased (p < 0.05). However, the arterial carbon dioxide partial pressure-end-tidal carbon dioxide partial pressure gradient remained constant throughout surgery. This gradient was highly correlated with arterial carbon dioxide partial pressure (p < 0.0001), but was not correlated with elapsed time, intra-abdominal pressure or head-up tilt. Arterial oxygen saturation was always greater than 95% in all patients and the arterial oxygen saturation-pulse oximetric saturation gradient was always less than or equal to +4%. In conclusion, end-tidal carbon dioxide partial pressure and pulse oximetric saturation allow reliable monitoring of arterial carbon dioxide partial pressure and arterial oxygen saturation in the absence of pre-existing cardiopulmonary disease and/or acute peroperative disturbance.
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