ISSN:
1432-055X
Schlagwort(e):
Schlüsselwörter Kalorimetrie
;
Stoffwechsel
;
Aortengabelrekonstruktion
;
Key words Oxygen uptake
;
Carbon dioxide production
;
Abdominal aortic reconstruction
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Beschreibung / Inhaltsverzeichnis:
Abstract Oxygen uptake (V˙O2) and carbon dioxide elimination (V˙CO2) can be measured with an indirect calorimeter; this method is well established in routine monitoring of ICU patients to evaluate metabolic state as a reflection of stress. In various experimental studies it was demonstrated that anaesthetics can influence whole-body metabolism. The purpose of this study was to examine whether indirect calorimetry can be used intraoperatively during routine anaesthesia and whether presumable changes in metabolism can be detected immediately. Abdominal aortic cross-clamping changes circulation, nutritional supply of the lower extremities and thus V˙O2 and V˙CO2. We therefore used this operation for our study. Method. Eleven patients, mean age 64 years, undergoing reconstruction of the aortic bifurcation, were studied. After premedication with piritramid and atropine, total intravenous anaesthesia (TIVA) was performed with fentanyl and midazolam after an induction with thiopental. Patients were ventilated with a Servo-Ventilator 900 D and a constant FiO2 of 0.5, without N2O. Routine monitoring consisted of ECG, pulsoximetry, CVP and continuous AP. V˙O2 and V˙CO2 were measured with a Deltatrac® (Datex), and data were registered every minute. For statistical evaluation we used a Wilcoxon-Ranksum test for matched pairs, p〈0.05 was considered significant. Data from specific time (5 min after intubation, 5 min before clamping; 5, 10 and 15 min after clamping, before declamping and 5 and 10 min after declamping and at the end of surgery) were calculated. In addition to absolute values, we compared the measured V˙O2 and V˙CO2 to baseline (5 min before clamping=MP2). Results. Mean operating time was 139 min±37; aortic cross-clamping time for the first extremity was 38 min and 55 min for the second. As expected, there was a significant decrease in V˙O2 (90% of baseline) and V˙CO2 (75% of baseline) during aortic cross-clamping. After declamping V˙O2 again rose to 110% of baseline, or to 103% for the second limb. V˙CO2 increased to only 90% and 82%, respectively. At the end of surgery V˙O2 reached baseline, whereas V˙CO2 remains at 83%. The respiratory quotient V˙CO2: V˙O2 was markedly reduced from 0.95±0.156 to 0.73±0.06 during surgery. The Deltatrac® showed every change in V˙O2 without delay; changes in V˙CO2 seem to occur somewhat retarded. Discussion. Aortic cross-clamping leads to a marked decrease in V˙O2 and V˙CO2 reflecting the temporary reduction in whole-body metabolism. Declamping results in a compensatory rise, especially in V˙O2. V˙CO2 seems to increase less after declamping, perhaps due to the CO2 pool of the organism or to a change in metabolism from carbohydrate to mainly fat oxidation. The results of this study demonstrate that indirect calorimetry can easily be performed during anaesthesia and surgery. Preconditions are a non-rebreathing system without airleak, constant FiO2〈0.6 and no use of nitrous oxide.
Notizen:
Zusammenfassung Veränderungen des Stoffwechsels sollten mit der indirekten Kalorimetrie unter Routinebedingungen bei Aortengabelrekonstruktionen untersucht werden. Elf männliche Patienten wurden in totaler intravenöser Anästhesie (TIVA) mit dem Servoventilator 900 D ohne Lachgase mit FiO 2 0,5 beatmet. Kalorimetriert wurde mit einem Deltatrac ® (Datex). Zur Auswertung wurden folgende Meßpunkte herangezogen: 5 min nach Intubation, 5 min vor Aorten-Klemme = Referenzwert, bei Klemmen; 5, 10, 15 min nach Öffnen; 1, 5, 10 min nach Öffnen und bei Operationsende. Zur statistischen Berechnung wurde der Student-t-Test für gepaarte Werte verwendet. Die Aortenklemmung führt zu einem Abfall von V˙O 2 (90% des Ausgangswertes) und V˙CO 2 (75% des Ausgangswertes) (Abb. 1, 2, 3). Das Öffnen der Klemme führt bei jedem Bein zu einem signifikanten Anstieg von V˙O 2 (118%); Die CO 2 -Produktion steigt etwas langsamer, ist jedoch für das 1. Bein ebenfalls signifikant (90%). Auffallend ist eine kontinuierliche Abnahme des respiratorischen Quotienten von (MP1) 0,98±0,11 bis zu 0,75±0,06 bei OP-Ende. Das dichte Nicht-Rückatmungssystem des Servo-Ventilators 900 D ermöglicht mit dem Deltatrac eine zuverläßliche, rasche und nicht invasive Messung von V˙O 2 und V˙CO 2 , wenn kein Lachgas verwendet wird und FiO 2 〈0,6 ist. Der Abfall des RQ von Narkose-Beginn bis OP-Ende uß als Zeichen einer vermehrten Fettverbrennung angesehen werden.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/s001010050188
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