Permissive Hypercapnia in an Obese Senior Dog: Anesthesia Case During Laparoscopic Surgery

Описание: This video presents an anesthesia case involving a 13-year-old, 6.6-kg Maltese dog with severe obesity (BCS 9/9) undergoing laparoscopic liver lobectomy.

Anesthesia was maintained under spontaneous ventilation, and end-tidal CO₂ (EtCO₂) exceeded 60 mmHg, consistent with permissive hypercapnia.
Given the patient’s obesity and reduced respiratory compliance, aggressive mechanical ventilation was avoided to prevent excessive airway pressures and ventilator–patient asynchrony.

Key points demonstrated in this case:

Obesity-related ventilatory limitation: Reduced functional residual capacity and increased work of breathing

Permissive hypercapnia: Elevated EtCO₂ tolerated while maintaining adequate oxygenation and hemodynamic stability

Clinical decision-making: Prioritizing overall physiologic stability rather than strict normalization of CO₂ values

Outcome: Surgery was completed uneventfully, recovery from anesthesia was smooth, and the patient was discharged 4 days postoperatively without major complications

This case highlights that, in selected patients, permissive hypercapnia can be a reasonable and safe anesthetic strategy when carefully monitored and clinically justified.

This video is intended for veterinarians, anesthesia providers, and students interested in practical ventilation strategies for high-risk obese patients.