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GENERAL ARTICLES

Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

Helmut Hager, MD^*, Dayakar Reddy, MD^*, Goutham Mandadi, MD^*, Debra Pulley, MD, J. Chris Eagon, MD, Daniel I. Sessler, MD^||, and Andrea Kurz, MD^¶

From the *Department of Anesthesiology, Washington University, St. Louis, MO; Department of Anesthesiology and General Intensive Care, Vienna General Hospital, University of Vienna, Vienna, Austria; Department of Surgery, Washington University, St. Louis, MO; Division of Colon-Rectal Surgery, Department of Surgery, Washington University, St. Louis, MO; ||Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH; ¶Department of Anesthesiology, University of Bern, Bern, Switzerland; Outcomes Research Institute, University of Louisville, Louisville, KY.

Address correspondence to Helmut Hager, MD, Department of Anesthesiology and General Intensive Care Medicine, Medical University Vienna, Austria. Address e-mail to H.Hager{at}gmx.at.

Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio₂) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given Fio₂ 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5 ± 17 kg/m²) scheduled for open gastric bypass were randomly assigned to normocapnia (n = 15, end-tidal Pco₂ 35 mm Hg) or hypercapnia (n = 15, end-tidal Pco₂ 50 mm Hg); Fio₂ was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and Pao₂ (222 ± 48 versus 230 ± 68 mm Hg in normocapnic versus hypercapnic; mean ± sd; P = 0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78 ± 31 versus 56 ± 13 mm Hg; P = 0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999