title: Impact of anaesthesia-surgery on D-dimer concentration and end-tidal CO2 and O2 in patients undergoing surgery associated with high risk for pulmonary embolism.
abstract: BACKGROUND
  The exhaled end-tidal CO2/O2 ratio and the D-dimer concentration are diagnostic markers of pulmonary embolism (PE).
  
  
  OBJECTIVE
  To develop a non-invasive technique to monitor for PE in surgical patients. We examine the change imparted by anaesthesia-surgery on the end-tidal CO2/O2 compared with the D-dimer.
  
  
  METHODS
  We enrolled 125 participants undergoing an orthopaedic or oncological operation thought to confer high risk for postoperative PE. We obtained preoperative blood samples in the anaesthesia clinic, and breath samples in the preoperative holding area on the same day of surgery; we repeated blood and breath samples on the postoperative day of discharge. Blood samples were immediately analysed for fibrinogen and D-dimer (Vidas; bioMérieux, Durham, NC, USA) concentrations. Breath samples were obtained from 1 min of spontaneous tidal breaths delivered via mouthpiece while the participant breathed room air. All participants had follow-up at 30 days.
  
  
  RESULTS
  We enrolled 125 participants and had complete data in 104. No participant developed PE or deep venous thrombosis within 30 days. The mean preoperative D-dimer was 927 +/- 928 ng ml(-1), and the mean postoperative D-dimer was 1879 +/- 1263 ng ml(-1) and the mean relative change was +234 +/- 292%. The mean preoperative end-tidal CO2/O2 was 0.31 +/- 0.05 and the mean postoperative end-tidal CO2/O2 was 0.32 +/- 0.07 and the mean relative change was +1.6 +/- 20%. The increase in D-dimer did not correlate with the increase in fibrinogen (r2 = 0.015).
  
  
  CONCLUSIONS
  The stress impact of anaesthesia-surgery causes less change in end-tidal CO2/O2 compared with the D-dimer. Further work will be required to determine if end-tidal CO2/O2 can be used to monitor for postoperative PE.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA. jkline@carolina.rr.com
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Hogg
authors.forename: David R
authors.initials: DR
authors.lastname: Mauerhan
authors.forename: Steven L
authors.initials: SL
authors.lastname: Frick
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D001944:Breath Tests; D002245:Carbon Dioxide / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects; D010100:Oxygen / Q000378:metabolism*; D011184:Postoperative Period; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002245:Carbon Dioxide; D005340:Fibrinogen; D010100:Oxygen