This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nekhendzy, V. Articles by Brock-Utne, J. G. Search for Related Content PubMed PubMed Citation Articles by Nekhendzy, V. Articles by Brock-Utne, J. G. Related Collections Neuroanesthesia Anesthetic Techniques Ventilation

---

NEUROSURGICAL ANESTHESIOLOGY

The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

Vladimir Nekhendzy, MD^*, Hendrikus J. M. Lemmens, MD, PhD^*, Winston C. Vaughan, MD, Edward J. Hepworth, MD, Alexander G. Chiu, MD, Christopher A. Church, MD, and John G. Brock-Utne, MD, PhD^*

From the Departments of *Anesthesiology, and Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.

Address correspondence and reprint requests to Vladimir Nekhendzy, MD, Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Drive Stanford, CA 94305-5640. Address e-mail to nek@.stanford.edu.

Abstract

BACKGROUND: Anesthetic management during functional endoscopic sinus surgery is aimed at minimizing bleeding and establishing a near-perfect surgical field. We investigated whether deliberate intraoperative hypercapnia and hypocapnia may affect blood loss and quality of surgical field through a proposed modulating effect of different carbon dioxide (CO₂) tension levels on nasal vasculature.

METHODS: One hundred and eighty patients were randomly assigned to normocapnia (end-tidal CO₂ [ETco₂] 37 ± 2 mm Hg), hypercapnia (ETco₂ 60 ± 2 mm Hg), and hypocapnia (ETco₂ 27 ± 2 mm Hg) groups. Anesthetic management was with propofol and remifentanil infusions, nitrous oxide, and moderate controlled hypotension. Blood loss and operating conditions were assessed by the surgeon who was blinded to group assignment. Differences among the study groups, the effect of the study group and time on ETco₂ levels and hemodynamic variables, and the association of blood loss with surgical covariates were analyzed.

RESULTS: There were no differences in blood loss and quality of surgical field among the study groups. Patients in the hypocapnia group demonstrated the highest, and in the hypercapnia group, the lowest, requirements for remifentanil, labetalol, and administration of the antihypertensive medications in general. The computed tomography-graded severity of sinonasal disease and duration of surgery were the only independent predictors of intraoperative blood loss.

CONCLUSIONS: CO₂ management during functional endoscopic sinus surgery does not influence operating conditions or blood loss.