[Intraoperative changes in arterial end tidal CO2 partial pressure difference in interventions with constant ventilation-perfusion ratio]. / Intraoperative Veränderungen der arterio-endtidalen CO2-Partialdruckdifferenz bei Eingriffen mit konstanten Ventilations-Perfusions-Verhältnissen.

ABSTRACT

During general anaesthesia, the endtidal CO2 pressure serves as an estimate of the arterial CO2 pressure to regulate the ventilator setting. Important arterial to end-tidal carbon dioxide tension differences (P(a-et)CO2) have been observed among patients undergoing procedures which have substantial impact on the ventilation-perfusion ratio (V/Q). Data on the P(a-et)CO2 for procedures in which the V/Q-ratio remains constant are lacking. Repeated measurements of P(a-et)CO2 in twelve patients with chronic obstructive lung disease (COLD) and nine pulmonary healthy patients undergoing jaw surgery were performed. The P(a-et)CO2 in the pulmonary healthy subjects (5.96 +/- 1.68 mmHg) was lower than in the COLD patients (9.05 +/- 3.49 mmHg) (p < 0.01). A clinically significant P(a-et)CO2 > or = 8 mmHg was observed in 52% of the measurements in patients with COLD compared with 11% in the pulmonary healthy subjects (p < 0.01). Both patient groups showed only minimal intraoperative changes of P(a-et)CO2. The deviation of all subsequent P(a-et)CO2 values from the initial P(a-et)CO2 was 2.17 +/- 1.52 mmHg in the pulmonary healthy patients and 2.02 +/- 1.49 mmHg in the patients with COLD (p = 0.76). Intraoperative changes of the P(a-et)CO2 are small during procedures with no major alterations of the V/Q ratio. For these procedures an initial measurement of the P(a-et)CO2 in patients with lung disease should be sufficient. In pulmonary healthy subjects the P(a-et)CO2 seems to be negligible.