Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients

A 2-month-old male 1.56 kg Yorkshire terrier (Case No. 1) and a 3-month-old male 2.3 kg Jack Russell Terrier (Case No. 2) were scheduled for ophthalmological surgery under general anaesthesia and neuromuscular blockade. For both patients, volume-controlled ventilation (VCV) was used with set tidal v...

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Bibliographic Details
Main Authors: Anastasia Papastefanou, Eva Rioja
Format: Article
Language:English
Published: MDPI AG 2023-02-01
Series:Animals
Subjects:
Online Access:https://www.mdpi.com/2076-2615/13/4/663
Description
Summary:A 2-month-old male 1.56 kg Yorkshire terrier (Case No. 1) and a 3-month-old male 2.3 kg Jack Russell Terrier (Case No. 2) were scheduled for ophthalmological surgery under general anaesthesia and neuromuscular blockade. For both patients, volume-controlled ventilation (VCV) was used with set tidal volumes (V<sub>T</sub>) of 13 mL/kg and 20 mL/kg for cases No. 1 and 2, respectively. The type of ventilator used did not take into account the intrinsic compliance of the breathing system; therefore, a significant part of the delivered V<sub>T</sub> was wasted in the expansion of the breathing system, and did not reach the patients, causing alveolar hypoventilation. Both cases developed low dynamic compliance (C<sub>D</sub>), and after a recruitment manoeuvre, EtCO<sub>2</sub> of up to 116 mmHg and 197 mmHg were revealed for cases No. 1 and 2, respectively. The two cases had to be ventilated manually, using positive inspiratory pressures (PIP) of 20–25 mmHg, in order to improve alveolar ventilation and reduce the EtCO<sub>2</sub>, as adjustments to the VCV were ineffective. Both patients maintained an oxygen haemoglobin saturation between 94% and 100% throughout the procedure and they recovered well. Using a higher V<sub>T</sub> from the beginning, to compensate for the compliance of the breathing system, or the use of pressure-controlled ventilation (PCV), could have potentially helped to avoid these two incidences of severe hypercapnia.
ISSN:2076-2615