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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 235-241
DOI: 10.1055/s-0044-1786699
Research Article

Variability of Resting Carbon Dioxide Tension in Patients with Intracranial Steno-occlusive Disease

Eric Plitman
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Lashmi Venkatraghavan
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Sanket Agrawal
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Vishvak Raghavan
2   Department of Computer Science, Faculty of Science, McGill University, Montreal, Quebec, Canada
,
Tumul Chowdhury
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Olivia Sobczyk
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Ece Su Sayin 
3   Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
,
Julien Poublanc
3   Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
,
James Duffin
4   Department of Physiology, University of Toronto, Toronto, Ontario, Canada
,
David Mikulis
3   Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
,
Joseph Fisher
1   Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations Funding This study was funded in part by a grant from MSH-UHN AMO AFP Innovation fund 2013-15.
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Abstract

Introduction Controlling the partial pressure of carbon dioxide (PaCO2) is an important consideration in patients with intracranial steno-occlusive disease to avoid reductions in critical perfusion from vasoconstriction due to hypocapnia, or reductions in blood flow due to steal physiology during hypercapnia. However, the normal range for resting PCO2 in this patient population is not known. Therefore, we investigated the variability in resting end-tidal PCO2 (PETCO2) in patients with intracranial steno-occlusive disease and the impact of revascularization on resting PETCO2 in these patients.

Setting and Design Tertiary care center, retrospective chart review

Materials and Methods We collected resting PETCO2 values in adult patients with intracranial steno-occlusive disease who presented to our institution between January 2010 and June 2021. We also explored postrevascularization changes in resting PETCO2 in a subset of patients.

Results Two hundred and twenty-seven patients were included [moyamoya vasculopathy (n = 98) and intracranial atherosclerotic disease (n = 129)]. In the whole cohort, mean ± standard deviation resting PETCO2 was 37.8 ± 3.9 mm Hg (range: 26–47). In patients with moyamoya vasculopathy and intracranial atherosclerotic disease, resting PETCO2 was 38.4 ± 3.6 mm Hg (range: 28–47) and 37.4 ± 4.1 mm Hg (range: 26–46), respectively. A trend was identified suggesting increasing resting PETCO2 after revascularization in patients with low preoperative resting PETCO2 (<38 mm Hg) and decreasing resting PETCO2 after revascularization in patients with high preoperative resting PETCO2 (>38 mm Hg).

Conclusion This study demonstrates that resting PETCO2 in patients with intracranial steno-occlusive disease is highly variable. In some patients, there was a change in resting PETCO2 after a revascularization procedure.

Keywords

resting PCO2 - cerebrovascular reactivity - intracranial atherosclerotic disease - moyamoya vasculopathy - steno-occlusive disease

Note

Controlling the partial pressure of carbon dioxide is an important consideration in perioperative neurosurgical care, as both hypocapnia and hypercapnia may lead to complications. This study shows that the resting (i.e., baseline) partial pressure of carbon dioxide in patients with intracranial steno-occlusive disease is highly variable and may be impacted by revascularization procedures. Further research is necessitated to improve our understanding of this phenomenon.


Prior Presentation

Organization: Canadian Anesthesiology Society Meeting


Place: Quebec City, Quebec. Canada


Date: June 10th, 2023


Authors' Contributions

E.P. contributed to conceptualization, experimental studies, data acquisition, and provided guarantee. L.V. helped in experimental studies. S.A. was involved in conceptualization, designing, literature search, clinical studies, experimental studies, data acquisition, statistical analysis, and provided guarantee. V.R., T.C., O.S., and E.S.S. contributed to conceptualization, designing, literature search, clinical studies, experimental studies, data analysis, statistical analysis, and provided guarantee. J.P., J.D., D.M., and J.F. helped in literature search and experimental studies and provided guarantee.


Ethical Approval

UHN REB # 22-5923, December 22, 2022


Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.




Publication History

Article published online:
06 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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