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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MDPI AG
2023-02-01
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| Series: | Animals |
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| Online Access: | https://www.mdpi.com/2076-2615/13/4/663 |
| _version_ | 1797622850699395072 |
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| author | Anastasia Papastefanou Eva Rioja |
| author_facet | Anastasia Papastefanou Eva Rioja |
| author_sort | Anastasia Papastefanou |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T09:16:06Z |
| format | Article |
| id | doaj.art-7f8ba6766910402aafa2af9b4c26032d |
| institution | Directory Open Access Journal |
| issn | 2076-2615 |
| language | English |
| last_indexed | 2024-03-11T09:16:06Z |
| publishDate | 2023-02-01 |
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| series | Animals |
| spelling | doaj.art-7f8ba6766910402aafa2af9b4c26032d2023-11-16T18:39:48ZengMDPI AGAnimals2076-26152023-02-0113466310.3390/ani13040663Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric PatientsAnastasia Papastefanou0Eva Rioja1Optivet Referrals, Ltd., Havant PO9 2NJ, UKOptivet Referrals, Ltd., Havant PO9 2NJ, UKA 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.https://www.mdpi.com/2076-2615/13/4/663hypercapniahypoventilationpaediatric patientmechanical ventilationdynamic compliancedead space |
| spellingShingle | Anastasia Papastefanou Eva Rioja Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients Animals hypercapnia hypoventilation paediatric patient mechanical ventilation dynamic compliance dead space |
| title | Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients |
| title_full | Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients |
| title_fullStr | Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients |
| title_full_unstemmed | Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients |
| title_short | Severe Hypercapnia during Anaesthesia under Mechanical Ventilation in Two Paediatric Patients |
| title_sort | severe hypercapnia during anaesthesia under mechanical ventilation in two paediatric patients |
| topic | hypercapnia hypoventilation paediatric patient mechanical ventilation dynamic compliance dead space |
| url | https://www.mdpi.com/2076-2615/13/4/663 |
| work_keys_str_mv | AT anastasiapapastefanou severehypercapniaduringanaesthesiaundermechanicalventilationintwopaediatricpatients AT evarioja severehypercapniaduringanaesthesiaundermechanicalventilationintwopaediatricpatients |