Abstract

PEREZ-BEDOLLA, MDP; MENDOZA-TRUJILLO, RDC; ALVAREZ-CANALES, JADJ  and  OROZCO-RAMIREZ, SM. Arterio-venous CO₂ deficiency as a prognostic marker of morbidity and mortality in patients undergoing neurological surgery. Anest. Méx. [online]. 2019, vol.31, n.2, pp.15-25. ISSN 2448-8771.

A pillar of the anesthetic planning is to prevent the tissue hypoperfusion. Its pathophysiological mechanism can hide against the instability of the quirurgico-anestesico event, therefore the importance of suspecting their presence is equally important as documenting it. The early identification and treatment improve the prognosis in the short and medium term. The utility of obtaining the value of the delta of CO2 (DCO2) as a marker of hypoperfusion in critical patients, has been found in other clinical settings, but its application in peri-operative of the neurosurgical patient has not been studied. Material and methods: 27 surgical patients were studied. Three measurements of the DCO2 were analyzed and related to the presence of organic failure, using SOFA scale, 24, 48 and 72 hours after surgery. The clinical relevance of values of DCO2 ˃ 6 mm Hg in neurosurgical adult patients, by obtaining venous and arterial blood gas, were evaluated to determine the gap of CO2. These measurements were made at the beginning of the anesthetic event, during and at the end of the surgery, his relationship with mortality and morbidity, organic failure defined by SOFA and documented within 72 hours of post-operative complications. Results. At the end of the surgical event DCO2 definition showed diagnostic utility in predicting complications; sensitivity 75%, specificity 95.7%, positive predictive value 75%, negative predictive value 95.7%. Conclusion: There is an association between the value of the DCO2 and prognosis of the Neurocritical patient. eing the determination of the final DCO2 which boasts a better forecast; However, the monitoring during the transanestesica phase is invaluable as part of the approach of the Neurocritical patient.

Keywords : Delta CO₂ (DCO₂); hypoperfusion; patients surgical neurocriticos.

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