Effects of capnometry monitoring during recovery in the post-anaesthesia care unit: a randomized controlled trial in adults (CAPNOSSPI).

PURPOSE: Continuous capnography should be used on patients admitted to post-anaesthesia care units (PACUs) with endotracheal tubes, but this monitoring is not always performed. Optimized ventilation in the PACU could be part of the global standards of practice to maintain the benefits of perioperative ventilation. The main objective was to study the rate of patients with alveolar hypoventilation before tracheal extubation or Laryngeal Mask Airway (LMA) removal upon the measurement of continuous capnography. METHODS: In this prospective, parallel-group, randomized controlled study, we enrolled adult patients admitted to the PACU after general anaesthesia with an endotracheal tube or LMA in place. Patients were randomly assigned to two groups: in the Capno + group, nurses managed the patients with access to the capnometer and end-tidal carbon dioxide pressure (PETCO2) measurements; in the Capno- group, nurses monitored the patients without seeing PETCO2 measurements. The primary outcome was the percentage of patients with PETCO2 measurements above 45 mm Hg during the minute before extubation. Secondary endpoints included the delay in recovering spontaneous breathing, rate of hypoxemia, delay before extubation, and length of stay in the PACU. RESULTS: Forty-eight patients were randomized into the two groups. The percentage of patients with PETCO2 > 45 mm Hg the minute before extubation was significantly decreased in the Capno + group (83.3% versus 54,1% in the Capno- and Capno + groups respectively, p = 0.029). There were no significant differences concerning secondary endpoints. CONCLUSIONS: The use of PETCO2 monitoring improves patient safety by decreasing the incidence of CO2 retention during recovery from general anaesthesia. This study suggests that this monitoring should be integrated in the PACU. The risk of hypoxemia can also be prevented through the early recognition of apnoea. CLINICAL TRIAL REGISTRY: clinicaltrial.gov. identifier: NCT03370081.

Pleural lipoma: a non-surgical lesion?

Pleural lipomas are benign tumours that develop at the expense of adipose tissues, and they never evolve towards liposarcoma. Located usually at the mediastinal, bronchial and pulmonary levels, a pleural situation is extremely rare. Chest X-rays usually detect them and computed tomography scans confirm the diagnosis. As complications occur, a wait-and-see policy is common. We report our pleural lipoma surgical exeresis experience since 1999. We have operated on five cases of pleural lipomas among nearly 1800 cases of thoracic exeresis: three male and two female patients, without obesity (in all cases, body mass index (BMI) < 28). The mean age was 54.6 years (range 35-72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas.