Indian Journal of Anaesthesia  
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Year : 2020  |  Volume : 64  |  Issue : 2  |  Page : 145-147

Positive end-expiratory pressure as a novel method to thwart CO2 leakage from capnothorax in robotic-assisted thoracoscopic surgery

Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India

Correspondence Address:
Dr. Muthapillai Senthilnathan
Department of Anaesthesiology and Critical Care, Hospital Block, Second Floor, JIPMER, Pondicherry - 605 006
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_627_19

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Capnography and end tidal CO2 (EtCO2) aids the anaesthesiologist in diagnosing problems during all phases of general anaesthesia. Negative arterial to end-tidal carbon-dioxide gradient during anaesthesia has been reported in various conditions including pregnancy, infants and inadvertent exogenous addition of carbon dioxide (CO2) to the expired gas in case of thoracoscopic procedures with iatrogenic injury to lung parenchyma/bronchial tree. Thus, airway injury or intentional opening of airway as a part of surgical step can be diagnosed using a negative arterial and end tidal CO2 gradient. Higher optimal PEEP can be used as a splint across the bronchial cuff in one-lung ventilation which prevents leak from capnothorax and decrease inadvertent entry of CO2 in to the expired gases which erroneously increase arteriolar to end tidal CO2 gradient.

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