caa a22 4500 475779355 CHVBK 20180406123640.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s004640010066 doi (NATIONALLICENCE)springer-10.1007/s004640010066 Reliable noninvasive parameters for early detection of cardiopulmonary compromise induced by carbon dioxide thoracoretroperitoneum in minimally invasive thoracolumboendoscopic spine surgeryrid=""id=""Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), San Antonio, Texas, USA, 24&ndash;27 March, 1999 [Elektronische Daten] [B. Vollmar, A. Olinger, U. Hildebrandt, M. D. Menger] Background: Using a novel endoscopic retroperitoneal approach for thoracolumbar anterior spine fusion, we examined the cardiopulmonary effects of the inevitably associated carbon dioxide (CO2) thoracoretroperitoneum and evaluated noninvasive parameters, which may provide early and adequate recognition of cardiopulmonary dysfunction. Methods: Under balanced anesthesia and paralysis, six pigs subjected to endoscopic CO2 thoracoretroperitoneal spine fusion underwent extensive pulmonary and hemodynamic online monitoring throughout the operative procedure. Open thoracophrenolumbotomy in six pigs served as a control procedure. Results: In contrast to unchanged cardiopulmonary parameters during open thoracolumbar spine surgery, CO2 thoracoretroperitoneum caused significant hypercapnia, hypoxia, and acidemia with concomitant tachycardia, pulmonary hypertension, and systemic hypotension. Ventilatory adjustment, CO2 evacuation, or both promptly reversed the cardiopulmonary effects. Noninvasively assessed end-tidal CO2, peak respiratory pressure, and heart rate were early clues for detecting the tension pneumothorax-like cardiopulmonary dysfunction, as indicated by a significant correlation with the invasively assessed pulmonary hemodynamic parameters and arterial blood gases. Conclusions: During endoscopic thoracolumbar spine fusion, CO2 thoracoretroperitoneum induces cardiopulmonary dysfunction, which, however, can be detected reliably by changes in end-tidal CO2, peak respiratory pressure, and heart rate, and which can be corrected immediately by appropriate ventilatory adjustments. Therefore, endoscopic CO2 thoracoretroperitoneal spine fusion might not necessarily require extraordinarily extensive and invasive monitoring of systemic and pulmonary hemodynamics, but ventilatory adjustment and intrathoracic pressure evacuation should be readily available to reexpand the lung, and to facilitate rapid normalization of hemodynamic conditions. Springer-Verlag New York Inc., 2000 Key words: Anterior spine fusion — CO2 insufflation — ETCO2— Hypercapnia — Hypoxia — Minimally invasive surgery — Peak respiratory pressure nationallicence Vollmar B. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut Olinger A. Department of Trauma Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut Hildebrandt U. Department of General Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut Menger M. D. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 820-824 0930-2794 14:9<820 2000 14 464 https://doi.org/10.1007/s004640010066 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640010066 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Vollmar B. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut NATIONALLICENCE 700 1- Olinger A. Department of Trauma Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut NATIONALLICENCE 700 1- Hildebrandt U. Department of General Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut NATIONALLICENCE 700 1- Menger M. D. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany, Germany aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 820-824 0930-2794 14:9<820 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer