Top

World Journal of Surgery

Published in:

01-06-2021 | Original Scientific Report

Correlation of Intraoperative End-Tidal Carbon Dioxide Concentration on Postoperative Hospital Stay in Patients Undergoing Pylorus-Preserving Pancreaticoduodenectomy

Authors: Ji-Hoon Park, Hye-Mi Lee, Chang Moo Kang, Kyung Sub Kim, Chul Ho Jang, Ho Kyoung Hwang, Jeong-Rim Lee

Published in: World Journal of Surgery | Issue 6/2021

Abstract

Background

Hypocapnia has been traditionally advocated during general anesthesia, even though it may induce deleterious physiological effects that result in unfavorable outcomes in patients. This study investigated the association between intraoperative end-tidal carbon dioxide (EtCO₂) and length of hospital stay (LOS) in patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD).

Methods

The medical records of 759 patients from 2006 to 2015 were reviewed. The patients were divided into two groups based on the mean EtCO₂ value during general anesthesia: the hypocapnia group (< 35 mmHg) and the normocapnia group (≥ 35 mmHg). The primary outcome was LOS between the groups. Secondary outcomes included the length of intensive care unit (ICU) stay, postoperative 30-day, 1-year, and 2-year mortality, and perioperative factors associated with LOS.

Results

A total of 727 patients were finally analyzed. The median LOS of the hypocapnia group was significantly longer than that of the normocapnia group (22 days vs. 18 days, respectively; p < 0.001). Postoperative mortality did not differ between the groups. Cox regression analysis revealed that hypocapnia was an independent risk factor for longer LOS (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.37–1.89; p < 0.001). Age and postoperative pancreatic fistula were also risk factors for a longer LOS.

Conclusions

It was concluded that low levels of intraoperative EtCO₂ during general anesthesia were associated with an increased LOS for patients undergoing PPPD.

Huttner FJ, Fitzmaurice C, Schwarzer G, et al. (2016) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2:Cd006053

Akkermans A, van Waes JAR, Thompson A et al (2019) An observational study of end-tidal carbon dioxide trends in general anesthesia. Can J Anaesth 66:149–160CrossRef

Curley G, Kavanagh BP, Laffey JG (2010) Hypocapnia and the injured brain: more harm than benefit. Crit Care Med 38:1348–1359CrossRef

Laffey JG, Kavanagh BP (2002) Hypocapnia. N Engl J Med 347:43–53CrossRef

Whitesell R, Asiddao C, Gollman D et al (1981) Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg 60:508–512CrossRef

Dony P, Dramaix M, Boogaerts JG (2017) Hypocapnia measured by end-tidal carbon dioxide tension during anesthesia is associated with increased 30-day mortality rate. J Clin Anesth 36:123–126CrossRef

Wax DB, Lin HM, Hossain S et al (2010) Intraoperative carbon dioxide management and outcomes. Eur J Anaesthesiol 27:819–823CrossRef

Way M, Hill GE (2011) Intraoperative end-tidal carbon dioxide concentrations: what is the target? Anesthesiol Res Pract 2011:271539PubMedPubMedCentral

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRef

10.

Gittell JH, Fairfield KM, Bierbaum B et al (2000) Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care 38:807–819CrossRef

11.

Saghaei M, Matin G, Golparvar M (2014) Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: a clinical trial. Adv Biomed Res 3:84CrossRef

12.

Mutch WAC, El-Gabalawy R, Girling L et al (2018) End-tidal hypocapnia under anesthesia predicts postoperative delirium. Front Neurol 9:678CrossRef

13.

Fleischmann E, Herbst F, Kugener A et al (2006) Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology 104:944–949CrossRef

14.

Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ et al (2015) Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest. Crit Care 19:348CrossRef

15.

Hovorka J (1982) Carbon dioxide homeostasis and recovery after general anaesthesia. Acta Anaesthesiol Scand 26:498–504CrossRef

16.

Fletcher R, Jonson B (1984) Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation. Effects of tidal volume and frequency of respiration. Br J Anaesth 56:109–119CrossRef

17.

Shankar KB, Moseley H, Kumar Y (1991) Negative arterial to end-tidal gradients. Can J Anaesth 38:260–261CrossRef

18.

Shankar KB, Moseley H, Kumar Y et al (1986) Arterial to end tidal carbon dioxide tension difference during caesarean section anaesthesia. Anaesthesia 41:698–702CrossRef

19.

Rich GF, Sconzo JM (1991) Continuous end-tidal CO₂ sampling within the proximal endotracheal tube estimates arterial CO₂ tension in infants. Can J Anaesth 38:201–203CrossRef

20.

Spadaro S, Karbing DS, Mauri T et al (2016) Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery. Br J Anaesth 116:855–861CrossRef

21.

Berger AC, Howard TJ, Kennedy EP, et al (2009) Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg 208:738–747; discussion 747–739

22.

Iacono C, Verlato G, Ruzzenente A et al (2013) Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 100:873–885CrossRef

23.

Raty S, Sand J, Lantto E et al (2006) Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy. J Gastrointest Surg 10:1131–1139CrossRef

Title: Correlation of Intraoperative End-Tidal Carbon Dioxide Concentration on Postoperative Hospital Stay in Patients Undergoing Pylorus-Preserving Pancreaticoduodenectomy
Authors: Ji-Hoon Park
Hye-Mi Lee
Chang Moo Kang
Kyung Sub Kim
Chul Ho Jang
Ho Kyoung Hwang
Jeong-Rim Lee
Publication date: 01-06-2021
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 6/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-021-05984-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Correlation of Intraoperative End-Tidal Carbon Dioxide Concentration on Postoperative Hospital Stay in Patients Undergoing Pylorus-Preserving Pancreaticoduodenectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2021

The World Journal of Surgery Welcomes Dr. Julie Miller to the Editorial Board

A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

The World Journal of Surgery Welcomes Dr. Liane Feldman to the Editorial Board

Elevation of High-sensitive Troponin T Predicts Mortality After Open Pancreaticoduodenectomy

The Association Between Burn Unit Census and Operative Intervention in a Resource-Limited Setting

Letter to the Editor: Patient Outcomes Following Emergency Bowel Resection for Inflammatory Bowel Disease and the Impact of Surgical Subspecialisation in the North of England: A Retrospective Cohort Study