CARBOXYHAEMOGLOBIN CONCENTRATIONS, PULSE OXIMETRY AND ARTERIAL BLOOD-GAS TENSIONS DURING JET VENTILATION FOR Nd-YAG LASER BRONCHOSCOPY

Oxygen saturation measured with pulse oximetry (SpO2) is overestimated in the presence of carboxyhaemoglobin (COHb). Smoke produced during laser resection of tracheobronchial malignancies may increase concentrations of COHb. We have measured COHb concentrations in 14 patients undergoing laser resect...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 1990-12, Vol.65 (6), p.749-753
Main Authors: GOLDHILL, D.R., HILL, A.J., WHITBURN, R.H., FENECK, R.O., GEORGE, P.J.M., KEELING, P.
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia
Anesthesia, Intravenous
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bronchial Neoplasms - surgery
Bronchoscopy
Carbon Dioxide - blood
Carboxyhemoglobin - analysis
Complications: carboxyhaemoglobin
Evaluation Studies as Topic
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
High-Frequency Jet Ventilation
Humans
laser resection
Laser Therapy - adverse effects
Medical sciences
Methemoglobin - analysis
Middle Aged
Monitoring: pulse oximetry
Oximetry
Oxygen - blood
Palliative Care
Surgery: tracheal
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Summary:Oxygen saturation measured with pulse oximetry (SpO2) is overestimated in the presence of carboxyhaemoglobin (COHb). Smoke produced during laser resection of tracheobronchial malignancies may increase concentrations of COHb. We have measured COHb concentrations in 14 patients undergoing laser resection and compared SpO2 with functional oxygen saturation (SaO2) to ascertain if pulse oximetry is an accurate monitor of oxygen saturation. During the procedure frequent changes occur in ventilatory mechanics. Arterial blood-gas tensions were measured to see if gas exchange was satisfactory. Mean preoperative COHb was 1.4%. There was no significant change in COHb in any patient at any stage during treatment. The highest value was 2.05%. The mean difference between SaO2 and SpO2 was 1.13% (95% confidence interval 0.70–1.56%). Oxygen saturation may therefore safely be monitored by pulse oximetry in patients managed by our technique. Empirical setting of a jet ventilator provided acceptable blood-gas tensions, although sometimes it was necessary to increase the FlO2 to > 0.3 to maintain oxy-genation.
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/65.6.749