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Cardiac function and hypercarbia

J P Rasmussen, P J Dauchot, R G DePalma

    Archives of Surgery (Chicago, Ill. : 1960)
    |October 1, 1978
    PubMed
    Summary
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    Hypercarbia during carotid endarterectomy increases cardiac workload and sympathetic activity, potentially leading to myocardial underperfusion despite elevated carotid stump pressure. Monitoring cardiac function is crucial.

    Area of Science:

    • Cardiovascular Physiology
    • Anesthesiology

    Background:

    • Carotid endarterectomy requires careful anesthetic management to maintain cerebral and myocardial perfusion.
    • Hypercarbia (elevated carbon dioxide levels) is sometimes used during anesthesia but its cardiovascular effects require thorough investigation.

    Purpose of the Study:

    • To assess cardiovascular responses to induced hypercarbia in patients undergoing carotid endarterectomy.
    • To evaluate the impact of hypercarbia on myocardial oxygen supply and demand balance.

    Main Methods:

    • 12 patients with heart disease undergoing carotid endarterectomy were studied.
    • Anesthesia was maintained with nitrous oxide and methoxyflurane.
    • Cardiovascular parameters including blood pressure, cardiac output, systolic time intervals (STI), and pressure time indices (PTI) were measured.

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  • Internal carotid artery stump pressure was monitored before and after hypercarbia induction.

    • Main Results:

    • Mild hypercarbia affected systolic time intervals but not heart rate or blood pressure.
    • Higher Paco2 levels (56-65 torr) increased blood pressure, heart rate, and cardiac output.
    • Increased mechanical cardiac activity was indicated by shortened preejection period (PEP) and left ventricular ejection time (LVET).
    • Hypercarbia induced significant sympathetic stimulation, evidenced by increased plasma catecholamines.
    • Cardiac oxygen demand rose, while coronary filling time decreased, suggesting relative myocardial underperfusion.
    • Internal carotid artery stump pressure increased with hypercarbia.

    Conclusions:

    • Hypercarbia to 66-70 torr increases internal carotid artery stump pressure but also elevates cardiac mechanical activity.
    • This creates an unfavorable balance between myocardial oxygen consumption and supply, indicating potential underperfusion.
    • Systolic time intervals and pressure time indices are valuable for detecting cardiac function alterations during hypercarbia.