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The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study.
Weinberg, L, Lee, DK, Gan, C, Ianno, D, Ho, A, Fletcher, L, Banyasz, D, Tosif, S, Jones, D, Bellomo, R, et al
BMC surgery. 2021;(1):31
Abstract
BACKGROUND It is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO2 during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes. METHODS A retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO2 and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery. RESULTS 289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m2). At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO2 changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r2 = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO2 the plasma potassium concentration increased by 0.18 mmol/L. CONCLUSION In patients receiving laparoscopic abdominal surgery, there is an increase in PaCO2 at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes. Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).
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The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients.
Tasaki, Y, Sueyoshi, E, Takamatsu, H, Matsushima, Y, Miyamura, S, Sakamoto, I, Mochizuki, Y, Uetani, M
Medicine. 2020;(36):e21890
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Abstract
The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ± 14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ± 21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.
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Transcutaneous carbon dioxide measurements in fruits, vegetables and humans: A prospective observational study.
Sochet, AA, Bessone, SK, Parilla, NW, Nakagawa, TA
European journal of anaesthesiology. 2019;(12):904-910
Abstract
BACKGROUND Transcutaneous carbon dioxide measurement (TcCO2) is frequently used as a surrogate for arterial blood gas sampling in adults and children with critical illness. Data from noninvasive TcCO2 monitoring assists with clinical decisions regarding mechanical ventilation settings, estimation of metabolic consumption and determination of adequate end-organ tissue perfusion. OBJECTIVES To report TcCO2 values obtained from various fruits, vegetables and elite critical care medicine specialists. DESIGN Prospective, observational, nonblinded cohort study. SETTINGS Single-centre, tertiary paediatric referral centre and organic farmers' market. PARTICIPANTS Vegetables and fruits included 10 samples of each of the following: red delicious apple (Malus domestica), manzano banana (Musa sapientum), key lime (Citrus aurantiifolia), miniature sweet bell pepper (Capsicum annuum), sweet potato (Ipomoea batatas) and avocado (Persea americana). Ten human controls were studied including a paediatric intensivist, a paediatric inpatient hospital physician, four paediatric resident physicians and four paediatric critical care nurses. INTERVENTIONS None. MAIN OUTCOME MEASURES TcCO2 values for each species and device response times. RESULTS TcCO2 readings were measurable in all study species except the sweet potato. Mean ± SD values of TcCO2 for human controls [4.34 ± 0.37 kPa (32.6 ± 2.8 mmHg)] were greater than apples [3.09 ± 0.19 kPa (23.2 ± 1.4 mmHg), P < 0.01], bananas [2.73 ± 0.28 kPa (20.5 ± 2.1 mmHg), P < 0.01] and limes [2.76 ± 0.52 kPa (20.7 ± 3.9 mmHg), P < 0.01] but no different to those of avocados [4.29 ± 0.44 kPa (32.2 ± 3.3 mmHg), P = 0.77] and bell peppers [4.19 ± 1.13 kPa (31.4 ± 8.5 mmHg), P = 0.68]. Transcutaneous response times did not differ between research cohorts and human controls. CONCLUSION We found nonroot, nontuberous vegetables to have TcCO2 values similar to that of healthy, human controls. Fruits yield TcCO2 readings, but substantially lower than human controls.
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The human central nervous system discharges carbon dioxide and lactic acid into the cerebrospinal fluid.
Akaishi, T, Onishi, E, Abe, M, Toyama, H, Ishizawa, K, Kumagai, M, Kubo, R, Nakashima, I, Aoki, M, Yamauchi, M, et al
Fluids and barriers of the CNS. 2019;(1):8
Abstract
BACKGROUND The central nervous system was previously thought to draw oxygen and nutrition from the arteries and discharge carbon dioxide and other metabolic wastes into the venous system. At present, the functional role of cerebrospinal fluid in brain metabolism is not fully known. METHODS In this prospective observational study, we performed gas analysis on venous blood and cerebrospinal fluid simultaneously acquired from 16 consecutive preoperative patients without any known neurological disorders. RESULTS The carbon dioxide partial pressure (pCO2) (p < 0.0001) and lactic acid level (p < 0.001) in the cerebrospinal fluid were significantly higher than those in the peripheral venous blood, suggesting that a considerable proportion of metabolic carbon dioxide and lactic acid is discharged from the central nervous system into the cerebrospinal fluid. The oxygen partial pressure (pO2) was much higher in the cerebrospinal fluid than in the venous blood, corroborating the conventional theory of cerebrospinal fluid circulatory dynamics. The pCO2 of the cerebrospinal fluid showed a strong negative correlation with age (R = - 0.65, p = 0.0065), but the other studied variables did not show significant correlation with age. CONCLUSION Carbon dioxide and lactic acid are discharged into the circulating cerebrospinal fluid, as well as into the venules. The level of carbon dioxide in the cerebrospinal fluid significantly decreased with age.
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[Normal values of gases in the vein of the umbilical cord during the postpartum period and postcesarea immediately in normal fetuses to term].
Bernardez-Zapata, FJ, Moreno-Rey, C
Ginecologia y obstetricia de Mexico. 2014;(3):170-6
Abstract
BACKGROUND To be able to diagnose and catalogue a patient with imbalance of the acid basic condition a gasometría must be realized. The pH and the gasometría of the blood of umbilical cord are useful tools to study the immediate situation of the newborn child. The values gasométricos in the vein and the artery of the umbilical cord change according to the geographical altitude. OBJECTIVE To identify the normal values of the venous gases of the umbilical cord in the postpartum immediate one of normal fetuses to term, born by obstetric resolution, without hurt, in the Spanish Hospital of the Mexico City and to identify the difference with the considered normal values for other institutions of different conditions of the Mexican Republic located to different altitudes. MATERIAL AND METHOD Transversal, prospective, descriptive and observacional study effected in the service of Obstetrics of the Hospital Español of Mexico (Maternidad Mundet). All the patients were included pregnant woman of term, with pregnancy of normal evolution, with an obstetric resolution without evidence of foetal hurt that they deposited with labor or for elective Caesarean. RESULTS The average of the curves of normal distribution of the pH, of the PCO2, of the HCO3, of the PO2, of the base excess and of the foetal hemoglobin they were: 7.34, 39.3081, 20.66, 29.3529,-4.09 and 15.18, respectively.The distribution curves of the analyzed values were normal, in no.case there was asymmetry, with a not significant Kolmogorov. CONCLUSIONS The gasometric of the cord is a simple, practical method and, especially I target to value the foetal condition intraparto. The values found in our analysis do not demonstrate statistically significant differences with the values of other studies effected to minor altitudes that that of the Mexico City. The analysis that here one presents is a partial check of the final sample that will belong 300 individuals.
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An exploratory study of respiratory quotient calibration and association with postmenopausal breast cancer.
Prentice, RL, Neuhouser, ML, Tinker, LF, Pettinger, M, Thomson, CA, Mossavar-Rahmani, Y, Thomas, F, Qi, L, Huang, Y
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2013;(12):2374-83
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Abstract
BACKGROUND The respiratory quotient (RQ), defined as the ratio of carbon dioxide exhaled to oxygen uptake, reflects substrate utilization when energy is expended. Fat and alcohol have RQ values of approximately 0.7, compared with 1.0 for carbohydrate, and approximately 0.8 for protein. Here, the association between RQ and postmenopausal breast cancer risk is studied. METHODS Paired RQ measurements were obtained, separated by approximately 6 months, for women in the reliability subset of a Women's Health Initiative (WHI) Nutrition and Physical Activity Assessment Study. Linear regression of the average of the paired log RQ assessments on a corresponding log food quotient (FQ) average and other study subject characteristics, including age, body mass index, race, and education, yielded calibration equations for predicting RQ. RESULTS Calibration equations, using any of food frequency, food record, or dietary recall data, explained an appreciable fraction of measured log RQ variation, and these were used to compute calibrated RQ estimates throughout WHI cohorts. Calibrated RQ estimates using 4-day food record (4DFR) data related inversely (P = 0.004) to (invasive) breast cancer risk in the WHI Dietary Modification trial comparison group, and corresponding RQ estimates using food-frequency data related inversely (P = 0.002) to breast cancer incidence in this cohort combined with the larger WHI observational study. CONCLUSION Although preliminary, these analyses suggest a substantially higher postmenopausal breast cancer risk among women having relatively low RQ. IMPACT RQ elevation could provide a novel target for breast cancer risk reduction.
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Comparison of three indirect calorimetry devices and three methods of gas collection: a prospective observational study.
Graf, S, Karsegard, VL, Viatte, V, Maisonneuve, N, Pichard, C, Genton, L
Clinical nutrition (Edinburgh, Scotland). 2013;(6):1067-72
Abstract
BACKGROUND & AIMS Indirect calorimetry was performed for a long time with the DeltatracII(®) device (Datex, Finland), considered as a reference but no longer produced. This study aims at comparing the energy expenditure (EE), the volume of oxygen (VO2) and carbon dioxide (VCO2) measured by two new available indirect calorimeters, the QuarkRMR(®) (Cosmed, Italy) and the CCMexpress(®) (MedGraphic,USA), using three different methods of gas collection, with the DeltatracII(®) in healthy subjects. METHODS Twenty-four healthy subjects (15 women and 9 men, age 53 ± 15 yrs, mean BMI 25.5 ± 7.1 kg/m(2)) underwent measurements of EE with DeltatracII(®) using canopy, QuarkRMR(®) using canopy and CCMexpress(®) using canopy, face tent and facemask. All measurements were performed for 10 min in random order. Results are presented as mean ± SD and compared by linear regression, repeated measure one-way ANOVA with Bonferroni's post hoc test and Bland & Altman test. RESULTS EE was 1630 ± 340 kcal for DeltatracII(®) and 1607 ± 307 kcal, 1741 ± 360 kcal, 1666 ± 315 and 1626 ± 336 kcal for QuarkRMR(®) and CCMexpress(®) with canopy, face tent and facemask, respectively (p = 0.001). Compared to DeltatracII(®), Bland & Altman test showed a mean EE difference (2SD) of 24(220)kcal for QuarkRMR(®), and -111(260) kcal, -36(304) kcal, 5(402) kcal for CCMexpress(®) with canopy, face tent and facemask, respectively. There was no systematic over- or underestimation with any device or gas collection method. CONCLUSION Mean EE was similar between QuarkRMR(®) and DeltatracII(®) but not between CCMexpress(®), in any mode of gas collection, and DeltatracII(®). Bland & Altman test shows a large variability in EE differences with both devices compared to DeltatracII(®), highlighting the need for refining their accuracy.