Hypocapnia Clinical Trial
Official title:
The Role of Perioperative Ventilation (Gas Exchange) During Intrabdominal Surgery on Cognitive Function: a Randomized Clinical Study
Abdominal surgery commonly requires perioperative relaxation and therefore controlled mechanical ventilation. However, respiratory support can be associated with minor, yet clinically significant changes in blood gas content. The inadvertent hyperoxia (excessively high oxygen) and/or hypocapnia (excessively low carbon dioxide) can result in transient changes in cerebral blood flow and cognitive impair.
The moderate hyperventilation resulting in hypocapnia as well as hyperoxia are common
features of mechanical ventilation during general anesthesia. While mild hyperventilation is
routinely advocated in laparoscopic surgical interventions, increased FiO2 is set to
reinforce safety of respiratory support. Hypocapnia may cause disturbances of cerebral blood
flow due to narrowing of cerebral vessels and a decrease cerebral blood flow. Hypocapnia is
particularly injurious to the brain in premature infants. Factors that may predispose the
immature brain to such injury include poorly developed vascular supply to vulnerable areas,
antioxidant depletion by excitatory amino acids, and the lipopolysaccharide and cytokine
effects that potentiate destruction of white matter. Data from neonates clearly suggest that
severe hypocapnia after hyperventilation contribute to adverse neurologic outcomes. The use
of high concentrations of oxygen can lead to a number of events such as the formation of
harmful free radicals and activation of lipid peroxidation, resulting in secondary brain
injury due to hyperoxia, particularly after suffering anoxia of the brain in resuscitated
victims of sudden cardiac arrest. It is recommended to use the fraction of oxygen to
maintain saturation at the level of 94-98% when performing cardiopulmonary resuscitation
(CPR), due to the risk of reperfusion injury. These disturbances of gas exchange, yet
transient can interfere in cerebral blood flow and therefore mental functions.
The primary aim of this study was the assessment of the impact of intraoperative gas
exchange (hypocapnia, hyperoxia and their combinations) on the state of higher nervous
activity
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Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention
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