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Intracellular buffering systems play an important role in tolerating severe hypercapnia. Although this case raised a great challenge to the homeostatic mechanism of the body, measures should be taken to maintain PCO2 values around the clinically acceptable level. Neonates are vulnerable to hypercapnia during anesthesia for their characteristic respiratory physiology. Heat and moisture exchange should be used with caution in newborns under general anesthesia as it can increase dead space. Intracellular buffering systems play an importan