Typical cases of perinatic bursts of high carbon dioxideemia are shared.

Patients with high levels of carbon dioxideemia during anesthesia may experience resuscation delays that even affect the functional recovery of brain cells.
to give our colleagues a more intuitive understanding, in this issue, we have identified a list of typical cases to share with you: patients, male, 62 years old, weight 80 kg.
was treated for colon cancer after infestation, matching mouth tear, emergency caesarean section.
patients are generally in good condition before surgery, check the electrolytic map is normal, blood pressure 140/90mmHg.
choose general anaesthetic intetugs, fentanyl, isofluoroane maintenance anesthesia, and vicobromine ammonium to maintain muscle relaxation.
operation lasted 1 hour and 40 minutes, after the operation to change the side position to L9-10 gap line epidural punctures, the installation of pain pump.
the patient is awake during the side sleep, has self-breathing, and has cough, breathing, high blood pressure, fast heart rate and so on.
the epidural external tube completed to change the receding position, immediately remove the air pipe catheter.
after pulling out the tube tongue fall, blood pressure rose to 210/130mmHg, heart rate 210 times / minute, the emergence of frequent pre-period contraction, ST segment down 0.15mV, oxygen saturation decreased.
patients are aware of the breathing frequency of 30 times / minute, considering the cardiovascular response to insekoue pain.
To give epidural injection 2% Lidoccain 20 ml did not improve, but also to give nitrate glycerin intravenous drip, hair glycerin C0.4 mg intravenous drip, blood pressure, heart rate did not drop significantly, SpO2 continued to decline, with mask oxygen absorption, SpO2 rose to 98%, after the mask fell.
blood gas: pH 7.125, PaO2117mmHg, PaCO2 87mmHg, BE-3.1mmol/L, diagnosed with high carbonateemia, to give mask-assisted breathing.
30 minutes after the blood pressure, heart rate dropped to preoperative level, electroen electrolytic map into sinuses, ST segment normal, stop oxygen absorption, SpO2 maintained at more than 93%, the review of blood gas did not see abnormalities.
, what do we think about the sudden onsum of high carbon dioxideemia during perinatic anesthesia? For laparoscopic surgery, patients often have underperseed emphysema, coupled with poor anaesthetic in surgery or poor parameter settings, it is very easy to lead to high carbon dioxideemia.
patients with primary lung disease, due to pulmonary breathing and pulmonary breathing dysfunction, it is also prone to sudden high carbon dioxideemia.
Therefore, during the whole hemp period, the anesthesiologist must have a more comprehensive understanding of the pathophysiology of the patient, but also pay attention to whether the anaesthetic machine can work properly and the parameters set during its work, but also pay attention to the windpit catheter air conditioning, etc. (sputum hydrant blockage, bending folding).
If PaCO2 is higher and lasts for a certain period of time, CO2 emission syndrome may occur when PaCO2 is treated for rapid decline, manifested as a drop in blood pressure, arrhythmic movement, arrhythmic disorders, and even a stop in the heartbeat, due to: (1) elevated PaCO2 The stress response suddenly disappears; (2) the dilation of blood vessels in the skeletal muscles, coupled with increased pressure in the chest during over-breathing, reduces the amount of blood in the heart, and (3) the sudden discharge of CO2 can cause coronary and cerebrovascular vessels to contract, resulting in insufficient blood supply to the heart and brain.
Therefore, for a period of time, the treatment of high carbon dioxideemia is to improve the artificial intake of patients with PaCO2 should be properly controlled, gradually increased, in addition to attention to blood volume supplementation, if necessary, the use of vascular active drugs.
source: Anaesthetic Medical Group !-- the end of the presentation -- !-- determine whether the login ends.