A call for standards on perioperative CO2 regulation

Coleman, Lewis S.

doi:10.1007/s12630-011-9469-7

Cited by 2 publications

(8 citation statements)

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“…In contrast, hypercarbia accelerates opioid clearance, exaggerates respiratory chemoreceptor sensitivity, ofsets opioid respiratory depression, and enables practical, safe opioid dosage that efectively controls surgical nociception and enhances outcome [43,44] . If opioid treatment is judiciously minimized, hyperventilated patients appear to breathe normally after anesthetic [3,4] . The nature of this phenomenon is generally misunderstood, so that it is called the "opioid hypersensitivity syndrome" [3,4] .…”

Section: Hypoventilation Hyperventilation Opioids and Anesthesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Carbon dioxide confusion has played a pivotal role in the evolution of modern anesthesia. Professional anesthesiology organizations have persistently neglected CO 2 management standards in favor of lesser issues [1][2][3][4] , so that the anesthesiology profession remains mired at the crossroads of revolutionary advance and ongoing self-destruction that can only be understood in historical context. Dr. Ralph Waters founded the profession on the basis of a practical new technique that introduced elective intubation and hyperventilation to abolish CO 2 toxicity disasters, but the harmful habit of hyperventilation has distorted anesthesia beliefs, habits, and practices; derailed research; halted professional advance; discouraged opioid treatment; abolished the therapeutic beneits of CO 2 ; exaggerated morbidity and mortality; and introduced a host of vexing clinical problems.…”

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confidence: 99%

“…The restoration of past principles using modern capnography, pulse oximetry, synthetic opioids, and improved inhalation agents promises to re-revolutionize surgical safety. This essay will review pertinent elements of CO 2 confusion, chemistry, physiology, pathology, mythology, and history to explain how present problems evolved, and why CO 2 standards are essential to restore professional progress and prestige, improve surgical safety and eiciency, preserve the profession, and facilitate future advance [1][2][3] .The Myth of CO 2 Toxic and Anesthetic Efects CO 2 confusion is hardly conined to anesthesia practice. Antiquated SCUBA literature B , arbitrary air quality standards C , the scientiically unfounded panic that followed the Apollo 13 disaster D , and global warming myths E exemplify endemic cultural fear of CO 2 that can be traced to the earliest days of gas research, when the efects of diferent gases were often confused with one another [6] .…”

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confidence: 99%

“…This may require several hours in geriatric patients with low metabolic rates. If the patient falls asleep for any reason during this vulnerable period, he may stop breathing and sufer brain damage or death [3,4] . 3.…”

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confidence: 99%

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Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

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Introduction Does wisdom perhaps appear on the earth as a raven, which is inspired by the smell of carrion? --Friedrich NietzschePast is prologue. Carbon dioxide confusion has played a pivotal role in the evolution of modern anesthesia. Professional anesthesiology organizations have persistently neglected CO 2 management standards in favor of lesser issues [1][2][3][4] , so that the anesthesiology profession remains mired at the crossroads of revolutionary advance and ongoing self-destruction that can only be understood in historical context. Dr. Ralph Waters founded the profession on the basis of a practical new technique that introduced elective intubation and hyperventilation to abolish CO 2 toxicity disasters, but the harmful habit of hyperventilation has distorted anesthesia beliefs, habits, and practices; derailed research; halted professional advance; discouraged opioid treatment; abolished the therapeutic beneits of CO 2 ; exaggerated morbidity and mortality; and introduced a host of vexing clinical problems. It has indirectly fostered the iction that further improvements in anesthesia safety are impossible, which has undermined reimbursement, emasculated staf privileges, devastated morale, discouraged professional membership A , and rationalized the replacement of anesthesiologists by nurses.Meanwhile, the confusing chemistry, physiology, and pathology of carbon dioxide have yielded their secrets, modern anesthesia machines have eliminated the toxicity problem, modern agents have eliminated explosions, and modern monitoring AbstractThe anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO 2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO 2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic technique that introduced elective intubation and hyperventilation to eliminate CO 2 toxicity, but mechanical hyperventilation dangerously depletes CO 2 tissue reserves and exaggerates morbidity and mortality. The beneits of CO 2 supplementation were forgotten, and consequent CO 2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in question. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and beneicial hypercarbia that complements opioid treatment and minimizes surgical morbidity and mortality. CO 2 reform promises revolutionary advance but faces formidable opposition. [5] . The restoration of past principles using modern capnography, pulse oximetry, synthetic opioids, and improved inha...

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Section: Hypoventilation Hyperventilation Opioids and Anesthesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

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30 Years Lost in Anesthesia Theory

Coleman¹

2012

CHAMC

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The recent discovery of the "Stress Repair Mechanism" (SRM) enables the Unified Theory of Medicine postulated by Hans Selye. It confers cohesive theories of anesthesia, analgesia, and allostasis that enable the alteration of anesthetic technique to optimize surgical outcome. The SRM continuously maintains and repairs the vertebrate body in accord with stressful forces and stimuli. Three synergistic pathways activate the SRM: the spinal pathway, the cognitive pathway, and the tissue pathway. Emotional mechanisms modulate the cognitive pathway, which explains allostasis. Surgery simultaneously stimulates all three synergistic pathways, causing harmful SRM hyperactivity that manifests as the Surgical Stress Syndrome. Anesthesia inhibits the cognitive pathway. Analgesia inhibits the spinal pathway. Synergistic combinations of anesthesia and analgesia minimize SRM hyperactivity better than either alone. This principle improves outcome, simplifies anesthetic technique, and minimizes polypharmacy and drug toxicity. Once verified, stress theory will advance surgical safety, accelerate recovery, minimize complications, reduce costs, enhance patient comfort, and guide pharmaceutical development to discover treatments that inhibit the tissue pathway, and thereby eliminate surgical stress altogether.

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A call for standards on perioperative CO2 regulation

Cited by 2 publications

References 6 publications

Four Forgotten Giants of Anesthesia History

Four Forgotten Giants of Anesthesia History

30 Years Lost in Anesthesia Theory

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