No, it didn't alter my management of CO2 during anesthesia. I have understood that CO2 is as essential as oxygen for oxygen transport and delivery. I routinely employ "permissive hypercarbia" during anesthesia to offset the respiratory depression caused by narcotics, and thereby optimize the therapeutic benefits of narcotics, which inhibit harmful nociception in spinal cord pathways. I have published a paper called "Four Forgotten Giants of Anesthesia History" (copy attached to this message) that summarizes the pathophysiology of carbon dioxide and the history of the deadly hoax that has promoted the notion that carbon dioxide has toxic and narcotic properties. Anyone interested should read my p

I clicked the wrong button and prematurely terminated my response to this question. The cause of postoperative dementia and delirium is surgical stress that induces hyperactivity of the "mammalian stress mechanism". The stress mechanism is activated via three synergistic pathways: 1. cognitive pathway, which is mediated by consciousness, which perceives nociception as pain and elevates harmful sympathetic nervous activity that harmfully releases von Willebrand Factor from the vascular endothelium, activates the capillary gate, and exaggerates microvascular flow resistance in organs and tissues. This causes oxygen starvation in organs and tissues, particularly the brain. 2. nociception pathway, which resists the effects of general anesthesia; in fact, general anesthesia exaggerates harmful nociception because it abolishes the inhibitory corticofugal pathways that inhibit spinal cord nociception 3. tissue disruption pathway, which activates factor VII by releasing tissue factor into systemic circulation. During general anesthesia I minimize inhalation agent toxicity and optimize narcotic analgesia by combining "permissive hypercarbia" with narcotic supplementation. This pretty much eliminates the problem of postoperative delirium and dementia, but the surgical stress syndrome cannot be completely controlled as of now for lack of a means to neutralize tissue factor released into blood circulation by surgical tissue disruption. I am preparing to publish a book that summarizes 20 years of literature research that has enabled the discovery and description of the mammalian stress mechanism. It will be published soon on Amazon and will be called "50 Years Lost in Medical Advance." Copies of my published papers and links to my YouTube slide shows can be found on my website: www.stressmechanism.com.

Interesting point. Normocarbia is essencial. Why to tolerate hyper? Patients breath spontaneously again when effect-site concentration of depressant drugs are washed.. Same rationale applies to hypocapnia ( moreover with your paper 10.3389/fneur.2018.00678). Let's keep homeostasis and normal physiological parameters during anesthesia! It is already too much to induce an abnormal state that is anesthetic unconsciousness!

I recommend that you read "Four Forgotten Giants of Anesthesia History." I'm sorry to inform you that you are the victim of a vicious hoax, and that your profession was founded on the basis of false science. Carbon dioxide has powerful therapeutic properties. In fact, it is arguably the most potent, safe, and useful medical therapy yet discovered. It optimizes all aspects of oxygen transport and delivery. When combined with narcotics, it becomes even more potent and useful. Seek and ye shall find. You can download the paper above.

Lewis S Coleman W. Alan C. Mutch Francisco a Lobo phenomenal discussion. Thank you all.