Continuous Intra-arterial Blood Gas Monitoring in Patients Undergoing Suprarenal Aortic Surgery

Abstract

The authors used an on-line, real-time, continuous blood gas monitor in 5 patients undergoing elective suprarenal aortic reconstruction. They retrospectively analyzed data to evaluate its utility in acid-base management and in detection of dynamic changes in oxygenation. Seven sets of data were analyzed since 1 patient underwent two additional periods of aortic crossclamping. A similar group of 7 patients undergoing elective suprarenal aortic surgery without continuous blood gas monitoring was analyzed and served as a control group. There was a highly significant mean decrease in partial pressure of oxygen (P0₂) of 158 mm Hg (P = 0.0060) with unclamping. In 1 patient the P0₂ dropped from 218 to 63 mm Hg within sixty seconds of unclamping, and this required immediate reinstitution of two-lung ventilation. Continuous availability of pH permitted accurate therapy with bicarbonate infusion during clamping. As a result there was no significant change in pH between preclamp and immediately after unclamping (P = 0.97). In the control group the pH decreased from a mean of 7.38 to a mean of 7.24 (P = 0.0005) between preclamp and after unclamping.

In summary, dynamic changes in oxygenation and pH are observed during suprarenal aortic surgery. Continuous blood gas monitoring provided data resulting in improved management of acid-base status and early detection of significant decreases in oxygenation.

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References

1. Baumgartner FJ , Bongard FS , Klein SR : Inadequate bicarbonate resuscitation in trauma patients requiring crossclamping of the aorta. Resuscitation 20:17-23, 1990.

2. Landow L , Visner MS : Does NaHCO3 exacerbate myocardial acidosis? J Cardiothorac Vasc Anesthes 7:340-351, 1993.

3. lafrati MD , Gordon G , Staples M : Transesophageal echocardiography for hemodynamic management of thoracoabdominal aneurysm repair. Am J Surg 166:179-185, 1993.

4. Larson CP , Siever A , Vender J : Evaluation of drift in an intra-arterial blood gas sensor. Anesthesiol 77:A538-A538,1992.

5. Depoix JP , Desmonts JM , Camus F , et al: Evaluation of a continuous blood gas monitor during open heart surgery. Anesthesiol 79:A538-A538, 1993.

6. Vender J , Gilbert H , O'Connor B , et al: Validation of continuous intra-arterial blood gas monitoring (CIABG) in coronary artery patients. Anesthesiol 79:A564-A564, 1993.

7. Haler M , Kilger E , Briegel J , et al: Continuous intraarterial blood gas monitoring in patients with severe respiratory failure. Anesthesiol 79:A566-A566, 1993.

8. Saleh SA , Crawford ES , Bomberger RA , et al: Intraoperative acid-base management for the resection of thoracoabdominal aortic aneurysms: A comparison of continuous infusion of sodium bicarbonate versus the bolus. Anesthes Analg 61:213-213, 1982.

9. Cartier R , Orszulak TA , Pairolero PC , et al: Circulatory support during crossclamping of the descending thoracic aorta. Evidence of improved organ perfusion. J Thorac Cardiovasc Surg 99:1038-1047, 1990.

10.

10. Severinghaus JW , Naifeh KH : Accuracy of response of six pulse oximeters to profound hypoxia. Anesthesiol 67:551-558, 1987.

11.

11. Murata K , Sanjo Y , Ikeda K : Continuous measurement of oxygen consumption and carbon dioxide production during abdominal aortic surgery. Jpn J Anesthesiol 34:1607-1613, 1985.

12.

12. Casthely PA , Dluzneski J , Jones R , et al: Superoxide dismutase and hemodynamic changes following aortic crossclamp release. J Cardiothorac Anesthes 2:450-454, 1988.

13.

13. Kirshner DL , Kirshner RL , Heggeness LM , et al: Spinal cord ischemia: An evaluation of pharmacologic agents in minimizing paraplegia after aortic occlusion. J Vasc Surg 9:305-308, 1989.