Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulmonary complications of laparoscopic surgery include subcutaneous emphysema, mediastinal emphysema, hypercarbia, and pneumothorax. Pneumothorax is a rare complication that may occur in patients with diaphragmatic defects. We report a case of intraoperative left-sided pneumothorax in a patient who had undergone an esophagogastrectomy for carcinoma 16 years previously. The mechanisms for development of this complication and its management are discussed.
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PMID:Intraoperative pneumothorax during laparoscopic cholecystectomy: a complication of prior transdiaphragmatic surgery. 811 62

The purpose of this study is to examine the relationship between mechanical factors and the load compensation during hypercapnia in emphysema. In 36 clinically stable patients, we conducted pulmonary function tests and hypercapnic ventilatory response (HCVR) tests with and without inspiratory flow-resistive loading (IRL) (17 cm H2O/L/s). The mean value of HCVR significantly decreased with IRL, while that of the mouth occlusion pressure (P0.1) response increased. Regardless of IRL, the HCVR values were correlated with FEV1/FVC and airway resistance. The load compensation, evaluated by the ratio of the HCVR value and the P0.1 response before and after IRL, was inversely correlated with percent FRC (r = -0.38, r = -0.39; both p < 0.05). Breathing pattern analysis at the end-tidal pressure of carbon dioxide of 55 mm Hg elicited the decrease of (tidal volume/inspiratory time (VT/TI) and the increase of TI and TI/TTOT. Although the absolute changes of VT and f were inconsistent among subjects, each relative ratio before and after IRL was correlated again with percent FRC (r = -0.46, r = 0.44: both p < 0.01). Therefore, the position of the inspiratory muscles at the onset of inspiration may influence the load compensation during hypercapnia in emphysema.
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PMID:Respiratory load compensation during hypercapnic ventilatory response in pulmonary emphysema. 818 26

A 41-year old, 50 kg female was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with thiopental 250 mg IV and endotracheal intubation was performed using succinylcholine 60 mg IV. Anesthesia was maintained with N2O (67%)-oxygen-sevoflurane (1.5-2%) and pancuronium was used for muscle relaxation. The lungs were mechanically ventilated with TV 500 ml and RR 12.min-1. Immediately after the start of incision, PECO2 was 30 mmHg. But about thirty minutes after introducing carbon dioxide pneumoperitoneum, subcutaneous emphysema and high PECO2 (60 mmHg) were noted and arterial blood gas analysis showed PaCO2 63.2 mmHg, PaO2 135.4 mmHg and pH 7.32. Generally in laparoscopic cholecystectomy, subcutaneous emphysema is more common than in gynecologic laparoscopy and especially with severe subcutaneous emphysema, there is a risk of hypercapnia. This is because carbon dioxide in subcutaneous tissue is more absorbable than that in peritoneal cavity. As carbon dioxide in subcutaneous tissue is absorbed continuously after the operation, the patient should be carefully observed postoperatively.
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PMID:[Severe subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy]. 831 2

Definition of lung emphysema is based on morphologic criteria (irreversible destruction of alveolar space). In advanced stages of the disease, emphysema may be suspected clinically, by lung auscultation, lung function tests, and radiology. In early stages, there are characteristic functional findings, such as an irreversible decrease in forced expiratory volumes or flows. These simple tests are easily available. In this article, the natural course of lung emphysema is described, based on long term changes in lung function. The typical discrepancy between normal airway resistance and a decrease in FEV1 allows suspicion of early emphysema. In the further development of emphysema, an increase of airway resistance together with hypercapnia indicates severe functional disturbances and cor pulmonale.
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PMID:[Long-term follow-up of pulmonary emphysema]. 837 43

The most frequent form of lung emphysema leading to respiratory failure is the tobacco bronchitis-induced type of emphysema the so called chronic obstructive pulmonary (lung) disease (COPD). Histologically the centrilobular or centriacinar emphysema is believed to develop due to elastase and oxidant overload with concomitant antiprotease deficiency. The alpha1-antitrypsin deficiency is a rare genetic defect leading also in non-smoking patients to early death due to panlobular or panacinar emphysema. The functional pattern of both emphysema types shows irreversible lung overinflation with severe mainly expiratory bronchial obstruction with various degrees of pulmonary hypertension alpha1-proteinaseNinhibitor deficiency emphysema is prophylactically treated with prolastine and if hypoxia (PaO2 > 55 mm/Hg) is present with long term oxygen therapy. If hypercapnia develops O2 Therapy is combined with non invasive pressure supported ventilation. Volume reducing surgery may precede. In nonsmoking emphysema patients long term oxygen therapy and later unilateral lung transplantation improves quality of life as well as life expectancy.
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PMID:[Pulmonary emphysema--lung transplantation]. 857 95

This animal model of emphysema exhibits the same abnormalities in respiratory mechanics as those seen in human emphysema. The histologic and radiographic findings also closely resemble changes of panacinar disease. Moreover, the progressive hypoxemia preceding hypercarbia also parallels the clinical course seen in human disease. Drawbacks of this model include the long time period required to develop significant changes and the cost of maintaining the animals for such a time period. Large cystic areas were not noted in our animals and one would have to turn to another model to address the problem of giant bullous emphysema. There is no ideal animal model of pulmonary emphysema, and the usefulness of an experimental model should be judged on how well it answers the specific questions. Significant information has been obtained using various animal models of emphysema in lung transplantation, diaphragmatic function, pulmonary hemodynamics, and in several other areas. The dog appears to be a suitable model for thoracic surgical research on emphysema.
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PMID:Experimental emphysema. 857 57

We evaluated the use of a lateral thoracoscopic approach for lung reduction surgery in patients with diffuse emphysema. Sixty-seven patients with a mean age of 61.9 years underwent operation. Operative side was determined by preoperative imaging. The procedures were laser ablation in 10 patients and stapler resection in 57 patients. Ten patients, including six of the 10 patients in the laser-only group had poor outcome (death or hospitalization longer than 30 days), leading us to abandon the laser technique. Of the remaining 57 patients undergoing primary stapled resection, duration of chest tube placement averaged 13 days (range 3 to 53 days) with a mean hospital stay of 17 days (range 6 to 99 days). Seven patients required ventilation for longer than 72 hours, six patients underwent conversion of the procedure to open thoracotomy, four patients acquired arrhythmias, and three patients were treated for empyema. There was one early death (1.7%), from cardiopulmonary failure. Forty patients returned for 3-month evaluation. Significant (p < 0.0001) improvements were seen in forced vital capacity (2.69 L after vs 2.26 L before) and forced expiration volume in 1 second (1.04 L after vs 0.82 L before), with 25 of 40 patients (63%) showing an improvement of more than 20%. Lung volume measures, in particular residual volume, fell significantly. Arterial blood gas analysis revealed that carbon dioxide tension fell significantly in patients with preoperative hypercapnia (carbon dioxide tension > 45 mm Hg, p = 0.018). Six-minute walk test results improved (894 feet after vs 784 feet before, p = 0.002), and symptomatic benefit was confirmed by significant improvement in the dyspnea index. The combination of both hypercapnia and reduced single-breath diffusing capacity for carbon monoxide was significantly more frequent (p = 0.0026) and was 86% specific (5 of 6 patients) in predicting serious postoperative risk. We conclude that the lateral thoracoscopic surgical approach to diffuse emphysema offers significant improvement in pulmonary mechanics and functional impairment. Patients with a combination of hypercapnia and reduced single-breath diffusing capacity for carbon monoxide should not be considered for this procedure because of significant perioperative risk.
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PMID:Unilateral thoracoscopic surgical approach for diffuse emphysema. 858 1

To investigate gas exchange response to exercise, we studied 16 male patients with moderate-to-serve airflow obstruction (forced expiratory volume in one second (FEV1) 39 +/- 10% of predicted value), mild-modest arterial hypoxaemia (arterial oxygen tension (Pa,O2) 9.6 +/- 0.87 kPa) and no arterial hypercapnia (arterial carbon dioxide tension (Pa,CO2) 5.04 +/- 0.45 kPa), referred to as emphysematous-type chronic obstructive pulmonary disease (COPD) clinical pattern. During maximal exercise tests, Pa,O2 increased by more than 0.3 kPa in eight patients (Group A) and fell by more than 0.3 kPa in the other eight patients (Group B). Pulmonary function tests, maximal inspiratory pressure at the mouth, values at maximum cycle incremental exercise and baseline arterial blood gases did not differ significantly between the two groups. We, therefore, showed that common pulmonary function measurements at rest and during exercise were not useful in identifying patients who underwent exercise-induced hypoxaemia. Furthermore, we suggest that patients with the same clinical pattern of chronic obstructive pulmonary disease and the same degree of airflow obstruction and gas exchange impairment could develop a different adaptation to a maximal exercise test, and that the presence of exercise-induced hypoxaemia might be related to pathological features of emphysema more than to different respiratory functional measurements.
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PMID:Exercise-induced hypoxaemia in emphysematous type chronic obstructive pulmonary disease. 868 Mar 76

The primary goal of this study was to evaluate differences in carbon dioxide metabolism between patients undergoing transperitoneal or extraperitoneal laparoscopic pelvic lymph node dissection (L-PLND) for staging of adenocarcinoma of the prostate (CaP). Eighteen candidates undergoing L-PLND were divided between the transperitoneal (N = 12) and extraperitoneal (N = 6) approaches. End-tidal partial pressure of CO2 (PeCO2) and minute volume of expired CO2 (VCO2) were considered indicators of CO2 absorption. These two parameters were monitored intraoperatively utilizing a metabolic cart and Ohmeda Rascal-II. The cardiostimulatory effect of increasing serum CO2 and the ventilatory countermeasures used to correct the iatrogenic hypercapnia associated with CO2 insufflation were also measured. With the exception of the region of CO2 insufflation, the operative procedure and perioperative care were identical for the two groups. Preoperative patient characteristics were similar. The mean time of CO2 insufflation was 136 minutes for the transperitoneal group and 120 minutes for the extraperitoneal group. The absorption of CO2 was significantly greater and more rapid during extraperitoneal L-PLND. This may be attributable to more profound CO2 absorption from the parietal peritoneal surface compounded by subcutaneous CO2 emphysema. Disruption of microvascular and lymphatic channels during the development of the extraperitoneal working space facilitates direct CO2 absorption into the intravascular space. A minor increase in heart rate and systolic blood pressure was noted during CO2 insufflation. In all but one patient (extraperitoneal group), hypercarbia and acidemia were prevented by an increased ventilatory rate. The potential dysrhythmogenicity of hypercarbia may contraindicate the extraperitoneal approach in patients with cardiopulmonary disease.
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PMID:Carbon dioxide homeostasis during transperitoneal or extraperitoneal laparoscopic pelvic lymphadenectomy: a real-time intraoperative comparison. 887 27

The mechanism causing finger clubbing in patients with lung cancer (LC) is still unclear. We compared age, cigarette consumption, data on blood gas analysis and pulmonary function tests among patients with LC with clubbing (n = 30) and without clubbing (n = 28) and among patients with pulmonary emphysema (PE) with (n = 11) and without clubbing (n = 17). We also examined serum concentrations of transforming growth factor beta 1 (TGF beta 1) and insulin-like growth factor-I (IGF-I) in the patients and healthy volunteers (n = 21). There were no differences in age or cigarette consumption. LC groups showed normal levels of Pao2 and Paco2, suggesting that neither hypoxaemia nor hypercapnia caused clubbing in these patients. The level of serum TGF beta 1 in patients with LC with clubbing was significantly higher than in other groups (P < 0.005), whereas levels of IGF-I did not differ among the groups. Our data suggest that TGF beta 1 may play a role in the mechanism of clubbing in patients with LC.
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PMID:Elevated serum transforming growth factor beta 1 level in primary lung cancer patients with finger clubbing. 888 46


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