Pilot study with air-automated sigmoid capnometry in abdominal aortic aneurysm surgery.
BACKGROUND
and objective Ischaemic colitis can be a serious complication after aortic surgery. The paucity of clinical symptoms makes its diagnosis particularly difficult and often delayed. Automated on-line tonometry is now proposed to monitor intestinal perfusion. This study was designed to assess the use of semi-continuous sigmoid-to-arterial [P(r-a)CO(2)] PCO(2) gap monitoring in aortic surgery to detect colonic ischaemia.


METHODS
This prospective clinical study was realized at the University Hospital of Lille, France, including eight males scheduled for abdominal aortic aneurysm surgery. Intraoperative and postoperative P(r-a)CO(2) values were compared with conventional monitoring and colonic mucosa aspect performed by sigmoidoscopy 48 h after surgery. Haemodynamic variables, O(2) delivery (DO(2)), O(2) consumption (VO(2)), O(2) extraction (ERO(2)), lactate, P(v-a)CO(2), P(r-a)CO(2) were measured peroperatively and every 4 h during a 48-h postoperative period.


RESULTS
Intraoperative P(r-a)CO(2) values increased significantly with the highest value (4.36 +/- 3.42 kPa) observed during aortic clamping when DO(2) was the most altered. P(r-a)CO(2) continued to deteriorate after surgery with the maximal values between 8 (4.79 +/- 3.85 kPa) and 12 (4.68 +/- 3.26 kPa) h after surgery. This peak was associated with a significant ERO(2) increase counterbalancing an increase of VO(2) whereas DO2 tended to decrease. P(r-a)CO(2) values began to decrease only at the end of the study. The highest values of P(r-a)CO(2) were registered in patients with the most altered haemodynamic variables, severe ischaemic colitis along with higher hospital lengths of stay.


CONCLUSIONS
Taken together, these data suggest that regional and automated capnometry may be easily used non-invasively to detect peroperative intestinal ischaemia in aortic surgery.
Lebuffe
G
G
Dèpartement d'anesthésie-réanimation II, Hôpital Claude Huriez, Lille, France.
Decoene
C
C
Raingeval
X
X
Lokey
J S
JS
Pol
A
A
Warembourg
H
H
Vallet
B
B
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001784:Blood Gas Analysis / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood / Q000378:metabolism*; D012809:Colon, Sigmoid / Q000098:blood supply / Q000378:metabolism*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010865:Pilot Projects; D011652:Pulmonary Circulation / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D014065:Tonometry, Ocular; D014656:Vascular Surgical Procedures
D002245:Carbon Dioxide