Abstract
We studied the levels of hypercarbia necessary to induce ventricular extrasystoles in one group of six subjects anaesthetized with halothane 1.3 MAC and in another group of six subjects anaesthetized with a 1.3 MAC combination of halothane and nitrous oxide, both before and during elective surgical procedures. Hypercarbia was induced progressively by total rebreathing to a maximum Pvco 2 value of approximately 11.0 kPa (83 torr). Pvco 2 values at which ventricular extrasystoles were first observed were taken as the Pvco 2arrhythmic thresholds.During anaesthesia alone in both groups, Pvco 2 arrhythmic thresholds were achieved in only one of six subjects and the median Pvco 2 thresholds were therefore greater than 11.0 kPa (83 torr). During halothane anaesthesia with surgery, thresholds were observed in all subjects and the median value was 9.1 kPa(68 torr). During halothane-nitrous oxide with surgery, thresholds were identified in three of six subjects and the median was greater than 10.7 kPa (80 torr). The thresholds during halothane with surgery were significantly less than the threshold or maximum Pvco 2values observed in each of the other three states (p values <0.05). The results indicate that during halothane anaesthesia, surgical stimulation markedly enhances the arrhythmogenic effect of added carbon dioxide and that, in the presence of surgery, a nitrous oxide-halothane mixture is less sensitizing than an equi-potent dose of halothane alone.
Résumé
Nous avons étudié les niveaux d’hypercarbie susceptibles de causer des extrasystoles ventriculaires sur un groupe de six sujets anesthésiés a l’halothane à la concentration de 1.3 MAC et sur un autre groupe de six sujets anésthesiés avec un mélange équivalent à 1.3 MAC comprenant halothane et protoxyde d’azote avant et pendant une chirurgie réglée. L’hypercarbie fut induite progressivement par “rebreathing” total à une valeur de Pvco2 maximale d’environ 11.0 kPa (83 torr). On a adopté comme seuil arrythmique les premières atteintes valeurs de Pvco2 au cours desquelles les extrasystoles ventriculaires ont fait leurs apparitions. Pendant l’anesthésie seule, dans les deux groupes, les seuils arrythmiques furent atteints dans seulement un des six sujets et les seuils médians de Pvco2 ont été alors plus élevés que 11.0 kPa (83 torr). Lors de I’anesthésie à l’halothane pendant la chirurgie, les seuils anesthésiques furent observés chez tous les sujets et la valeur médiane a été de 9.1 kPa (68 torr). Lors de l’anesthésie à l’halothane-protoxyde d’azote administré pendant la chirurgie, les seuils ont été atteints dans trois des six sujets et la médiane a été plus élevée que 10.7kPa(80 torr). Les seuils obtenus pendant l’anesthésie a l’halothane avec chirurgie furent moins élevés de façon significative que le seuil où les valeurs maximales de Pvco2 observé dans chacun des trois autres états (p < 0.05). Ces résultats montrent que pendant l’anesthésie à l’halothane la stimulation chirurgicale augmente de façon marquée les effets arrythmogéniques causes par l’addition de gaz carbonique et que pendant la chirurgie un mélange protoxyde d’azote-halothane est moins sensibilisant qu’une dose équipotente d’halothane seule.
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Abbreviations
- Paco2 :
-
arterial CO2 tension
- [H+]a:
-
arterial hydrogen ion concentration
- Petco2 :
-
end-tidal CO2 tension
- Peto2 :
-
end-tidal O2 tension
- Pvco2 :
-
mixed venous CO2 tension (oxygenated)
- H.R.:
-
heart rate
- B.P.:
-
mean blood pressure
- S.E.M.:
-
standard error of the mean.
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Robertson, B.J., Clement, J.L. & Knill, R.L. Enhancement of the arrhythmogenic effect of hypercarbia by surgical stimulation during halothane anaesthesia in man. Canad. Anaesth. Soc. J. 28, 342–349 (1981). https://doi.org/10.1007/BF03007801
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DOI: https://doi.org/10.1007/BF03007801