CO2 changes during GA

4th lecture / practical anesthesia

By dr.Amassi Yakdhan
2023_ 2022
 Common tricks
• Normal blood value of PaCO2 = • CO2 travelling :
35- 45 mmHg by ABG
• 💪➡️🫀➡️🫀
• Normal reading in capnography • Metabolism ➡️Transport
PaCO2 = 30 – 43 mmHg .
➡️ventilation
• ETCO2 ⬆️ or ⬇️
• It’s the 1rst alarm to the changes
before Pulse O2 & ECG .
 ETCO2 reading changes
• ⬆️ ETCO2 = • ⬇️ETCO2 =
• ⬆️ muscular activity 💪 • ⬇️ muscular activity 💪as muscle
relaxant .
• malignant hyperthermia 🥵
• ⬆️C.O.P 🫀
• Hypothermia 🥶
• ⬇️ minute ventilation 🫀
• ⬇️ C.O.P 🫀

• Drugs of tx bronchospasm
• ⬆️ minute ventilation 🫀

• Bicarbonate infusion
• Bronchospasm

• Tourniquet release
 Dead space
Total dead space
anatomical alveolar mechanical
⬇️ .⬇️ .⬇️
Aiways till alveoli Ventilated not perfusion Artificial air way circut
Normal wave of capnography
 Capnography indications
• ETT accurancy • Complication that cause ⬇️or ⬆️
CO2 production :
• Disconnection or obstruction of
circuit • Pulmonary edema
• Rebreathing • Pulmonary embolism
• Hypoventilation • Airway disease ( asthma , COPD ) .
• Adjustment of muscle relaxant • estimate C.O.P & CPR accurancy .
• Adjustment of mechanical ventilator
parameters
Cases
• Apnea
• Air way obstruction
• dislodge to esophagus
• Air way disconnection
• C.V.S collapse
• Death .
Cases
• Base line elevated ➡️ rebreathing
• Causes of rebreathing :
• Malfunction CO2 absorber
• Inadequate inspiratory flow
• In sufficient expiratory flow
• Faulty expiratory flow
Cases
• Notch sign : muscle relaxant start
to fade away .
Cases
• Obstruction :
• ETT occlude , kinking ,
obstruction
• Circuit obstruction
• Bronchospasm
Cases
• Hyper ventilation Or
⬇️ETCO2
• Causes :
• ⬆️ RR
• ⬆️ TV
• ⬇️ BMR
• ⬇️Hypothermia
Cases
• Hypoventilation Or ⬆️ ETCO2
• Causes :
• ⬇️ RR
• ⬇️ TV
• ⬆️ BMR
• ⬆️Hyperthermia
Cases
• Inadequate seal around :
• ETT deflate , leakage or too small
to the airway .
Cases
• Esophageal tube ➡️ esophagus
has little or no amount of CO2 .
• ETCO2 is the 1rst indicator for
esophageal intubation.