Extradural Hematoma With Unanticipated Difficult Intubation Due to Rhinoscleromatosis (original) (raw)

Journal of Neurosurgical Anesthesiology, 2017

Abstract

ETCO2, such as inadequate ventilation, increase in dead space, and increased metabolism such as fever, partial muscle relaxation, and exhausted soda lime causing partial rebreathing were all ruled out in our case. We postulate that in presence of raised ICP, to maintain a constant cerebral blood flow, the body reacts by increasing the systemic vascular resistance (SVR).1,2 This increase in SVR diverts the systemic splanchnic blood to pulmonary circulation, thereby increasing the cardiac output to maintain a constant cerebral perfusion pressure. This increase in pulmonary blood flow will increase the ETCO2 and decreases the pulmonary compliance.3–5 In our case, the increase in ETCO2 despite an adequate ventilatory setting could be due to the above-mentioned effect. After the ventricular tapping, a transient decrease in blood pressure and an improvement in ventilation (ETCO2 decrease) could be explained by a decrease in SVR and causing decrease in pulmonary blood flow. From this case, we wanted to highlight that aggressive ventilation to maintain a normal ETCO2 can dangerously increase the ICP by increasing the airway pressure, especially in neonates with poor intracranial compliance. One limitation of this report is that we did not perform a blood gas test to determine the correlation between the arterial CO2 and ETCO2.

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