Related Experiment Video
Updated: May 12, 2026
07:46
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
[A case of prolonged hypercapnea after interscalene brachial plexus block]
Yumiko Kohno1, Keiko Koishi, Kazunori Watanabe
1Department of Anesthesiology and Critical Care, Higashi Omiya General Hospital, Saitama 337-0051.
Masui. the Japanese Journal of Anesthesiology
|April 3, 2013
Summary
This case study highlights prolonged hypercapnia in an elderly patient with reduced lung function after surgery. Phrenic nerve palsy and sedation likely contributed to this respiratory complication.
Area of Science:
- Anesthesiology
- Pulmonology
- Geriatric Medicine
Background:
- An 83-year-old female with a history of lung cancer, rheumatoid arthritis, and pneumonia underwent surgery for bilateral extremity fractures.
- The patient presented with thoracic fluid retention, indicating compromised respiratory reserve.
Observation:
- Spinal anesthesia for femoral fracture repair was followed by interscalene brachial plexus block and sedation for olecranon fracture surgery.
- Post-block, the patient experienced a significant drop in oxygen saturation and required intubation due to severe hypercapnia (PaCO2 > 150 mmHg).
Findings:
- Following extubation, the patient required mask CPAP and exhibited persistent hypercapnia (PaCO2 90-100 mmHg) for three days.
- Phrenic nerve palsy, potentially induced by the interscalene block, combined with sedation and pre-existing lung disease, is suspected as the cause of prolonged hypercapnia.
Implications:
- This case underscores the importance of careful anesthetic management and monitoring in elderly patients with diminished lung function.
- It highlights the potential for prolonged hypercapnia resulting from the combined effects of regional anesthesia, sedation, and pre-existing respiratory compromise.
Related Concept Videos
01:30Acute Respiratory Failure-III
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without causing...
01:26Pneumothorax-I
A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
01:25Hyperpnea and Hyperventilation
Hyperventilation refers to a higher-than-normal rate and depth of breathing, often associated with anxiety attacks. This excessive breathing surpasses the body's need to expel CO2, leading to a condition known as hypocapnia - an unusually low level of carbon dioxide in the blood. Hypocapnia can constrict cerebral blood vessels, reducing blood flow to the brain, which may result in dizziness or fainting. Early signs include tingling and muscle spasms in the hands and face, caused by falling...
01:08Pneumothorax II: Pathophysiology
Pneumothorax means the presence of air in the pleural space — the thin potential gap between the visceral and parietal pleura. This condition disrupts the normal pressure balance that keeps the lungs inflated, leading to partial or complete collapse of the affected lung.Normal physiologyUnder normal conditions, the pleural space maintains a slightly negative intrapleural pressure, which keeps the lungs expanded against the chest wall. This negative pressure creates a delicate balance between...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
01:30Alterations in Respiration II
There are numerous types of normal and abnormal respiration. Based on ventilatory movements, breathing patterns are classified as regular, deep, or shallow. Examples include Biot's breathing, Cheyne-Stokes respiration, Kussmaul's breathing, hyperventilation, and hypoventilation. Each pattern is clinically significant and aids in evaluating patients.
In Biot's breathing, the respiratory rate and depth are irregular, alternating between periods of deep gasping and apnea. Common causes include...
In Biot's breathing, the respiratory rate and depth are irregular, alternating between periods of deep gasping and apnea. Common causes include...