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Bukoski A, Downs J, Hodgson DS, Le-Bert CR, Thomen R, Flors L, Thombs L, Bailey J. Cardiopulmonary effects of apneustic anesthesia ventilation in anesthetized pigs: a new mode of ventilation for anesthetized veterinary species. Front Vet Sci 2024; 11:1378617. [PMID: 38855412 PMCID: PMC11157129 DOI: 10.3389/fvets.2024.1378617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Objective To compare the cardiopulmonary effects of apneustic anesthesia ventilation (AAV) and conventional mechanical ventilation (CMV) in anesthetized pigs and to describe a new mode of ventilation for anesthetized veterinary species. Study design Randomized, crossover design without washout. Animals Twelve healthy, female white Landrace pigs. Methods Following ketamine-midazolam premedication and anesthetic induction with propofol, the trachea was intubated, and each pig was positioned in dorsal recumbency. Anesthesia was maintained with propofol and sufentanil infusions. Pigs were instrumented and their lungs were sequentially ventilated with each mode, in random order, for 1 h according to predefined criteria [fraction of inspired oxygen (FiO2) = 0.21, 10 mL kg-1 tidal volume (VT), and arterial carbon dioxide tension (PaCO2) within 40-45 mmHg]. Cardiopulmonary data were collected at baseline, 30 and 60 min. In 8 pigs, thoracic computed tomography (CT) was performed following the 60 min time point for each mode of ventilation and images were analyzed to quantify lung aeration. The effects of ventilation mode, time, and order were analyzed using repeated measures ANOVA. Paired t-tests were used to compare lung aeration between modes. Significance was defined as p < 0.05. Results Data from 12 pigs were analyzed. A significant effect of mode was found for heart rate, mean arterial pressure (MAP), pulmonary artery occlusion pressure, cardiac index (CI), stroke volume index, systemic vascular resistance, pulmonary vascular resistance, oxygen delivery index (DO2I), oxygen extraction ratio (O2ER), VT, arterial oxygen tension, arterial hemoglobin saturation, PaCO2, end-tidal carbon dioxide tension, alveolar dead space (VDalv/VTalv), venous admixture (Q . s / Q . t ), mean airway pressure, and dynamic compliance index (CRSI). Order effects were also observed for some cardiovascular and respiratory variables. For the eight pigs that underwent thoracic CT, AAV resulted in significantly larger proportions of normally and hyperaerated lung while CMV resulted in larger proportions of hypoaerated and atelectatic lung. Conclusions In dorsally recumbent anesthetized pigs, ventilated with FiO2 = 0.21, both modes of ventilation supported adequate oxygenation while AAV resulted in higher CRSI, and lower VDalv/VTalv andQ . s / Q . t , compared with CMV. AAV was also associated with lower MAP, CI, and DO2I and higher O2ER compared with CMV. Further investigation of AAV in anesthetized animals is warranted.
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Affiliation(s)
- Alex Bukoski
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - John Downs
- Innovative Veterinary Medicine, Ponte Vedra, FL, United States
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - David S. Hodgson
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Carolina R. Le-Bert
- U.S. Navy Marine Mammal Program, Naval Information Warfare Center Pacific, San Diego, CA, United States
| | - Robert Thomen
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Lucia Flors
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lori Thombs
- Department of Statistics, College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - James Bailey
- Innovative Veterinary Medicine, Ponte Vedra, FL, United States
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Mirra A, Gamez Maidanskaia E, Carmo LP, Levionnois O, Spadavecchia C. How is depth of anaesthesia assessed in experimental pigs? A scoping review. PLoS One 2023; 18:e0283511. [PMID: 36952576 PMCID: PMC10035875 DOI: 10.1371/journal.pone.0283511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Despite the large number of pigs involved in translational studies, no gold standard depth of anaesthesia indicators are available. We undertook a scoping review to investigate and summarize the evidence that sustains or contradicts the use of depth of anaesthesia indicators in this species. METHODS Medline, Embase and CAB abstract were searched up to September 22nd 2022. No limits were set for time, language and study type. Only original articles of in vivo studies using pigs or minipigs undergoing general anaesthesia were included. The depth of anaesthesia indicators reported in the selected papers were divided in two categories: A, indicators purposely investigated as method to assess depth of anaesthesia; B, indicators reported but not investigated as method to assess depth of anaesthesia. RESULTS Out of 13792 papers found, 105 were included after the screening process. Category A: 17 depth of anaesthesia indicators were found in 19 papers. Studies were conducted using inhalant anaesthetics as the main anaesthetic agent in the majority of the cases (13/19 = 68.4%), while 3/19 (15.8%) used propofol. The most investigated depth of anaesthesia indicators were bispectral index (8/19 = 42.1%) and spectral edge frequency 95% (5/19 = 26.3%). Contrasting results about the specific usefulness of each depth of anaesthesia indicators were reported. Category B: 23 depth of anaesthesia indicators were found in 92 papers. The most reported depth of anaesthesia indicators were: motor response following a stimulus (37/92 = 40.2%), depth of anaesthesia scores (21/92 = 23.3%), bispectral index (16/92 = 17.8%) and spectral edge frequency 95% (9/92 = 9.8%). CONCLUSION Results highlight the lack of scientifically valid and reliable indicators to ensure adequate depth of anaesthesia in pigs.
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Affiliation(s)
- Alessandro Mirra
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ekaterina Gamez Maidanskaia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Luís Pedro Carmo
- Department of Clinical Research und Public Health (DCR-VPH), Vetsuisse Faculty, Veterinary Public Health Institute, University of Bern, Bern, Switzerland
- Norwegian Veterinary Institute, Ås, Norway
| | - Olivier Levionnois
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Claudia Spadavecchia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Sakata DJ. Carbon Dioxide as the Other Therapeutic Carrier Gas? Anesth Analg 2022; 135:60-61. [PMID: 35709445 DOI: 10.1213/ane.0000000000006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Derek J Sakata
- From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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Midon M, Yamada DI, Filho DZ, Natalini CC, Escobar A, Clark-Price SC. Evaluation of the effects of doxapram in combination with xylazine on recovery of horses isoflurane-anesthetized. J Equine Vet Sci 2022; 111:103872. [DOI: 10.1016/j.jevs.2022.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Hypercapnia versus normocapnia for emergence from desflurane anaesthesia: Single-blinded randomised controlled study. Eur J Anaesthesiol 2021; 38:1148-1157. [PMID: 34313609 DOI: 10.1097/eja.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapid emergence from general anaesthesia is desirable only if safety is not sacrificed. Mechanical hyperventilation during hypercapnia produced by carbon dioxide infusion into the inspired gas mixture or by rebreathing was reported to shorten emergence time from inhalation anaesthesia. OBJECTIVES To test the hypothesis that hypercapnia produced by hypoventilation before desflurane cessation shortens emergence time from general anaesthesia (primary hypothesis) and reduces undesirable cardiorespiratory events. DESIGN A single-blinded randomised controlled study. SETTING A single university hospital. PATIENTS Fifty adult patients undergoing elective abdominal surgery under general anaesthesia using desflurane inhalation and intra-operative epidural anaesthesia. INTERVENTION The patients were randomly assigned to either the normocapnia or hypercapnia group. MAIN OUTCOME MEASURES Emergence time from desflurane anaesthesia and comparison of the incidence of 11 predefined undesirable cardiorespiratory events during and after emergence from anaesthesia between the groups. RESULTS Forty-six patients were included in the analysis. End-tidal carbon dioxide concentrations at cessation of desflurane were 35 ± 6 mmHg (mean ± SD) and 52 ± 6 mmHg in normocapnia (n = 23) and hypercapnia groups (n = 23), respectively. Emergence time was significantly faster in the hypercapnia group than the normocapnia group: 9.4 ± SD min, hypercapnia: 5.5 ± 2.6 min, (P < 0.001) with a difference of 3.8 min on average (95% CI: 2.4 to 5.3). Spontaneous breathing established before recovery of consciousness was more evident in hypercapnia patients (normocapnia: 13%, hypercapnia: 96%, P < 0.001). Hypercapnia patients had more episodes of bradypnoea and apnoea before emergence of consciousness. In contrast, after tracheal extubation, incidences of bradypnoea and hypopnoea were more common in the normocapnia group. Undesirable cardiovascular events were not common, and no group differences were observed during emergence and postextubation periods. CONCLUSION Hypoventilation-induced hypercapnia before desflurane cessation shortens the emergence time without causing additional clinically significant undesirable events. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000020143) https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&recptno=R000023266&language=E.
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Terlouw EMC, Deiss V, Astruc T. Stunning of pigs with different gas mixtures: Behavioural and physiological reactions. Meat Sci 2021; 175:108452. [PMID: 33588243 DOI: 10.1016/j.meatsci.2021.108452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
The present study used thirty-one pigs to investigate induction of unconsciousness and behavioural reactions in different gas mixtures: 80% CO2/air, 90 s; 40% CO2/30% O2/air, 180 s; 70% N2O/30% CO2, 90 s. All pigs lost consciousness. All presented respiratory difficulties and most pigs involuntary muscle contractions, often before loss of standing posture. Between mixtures, average latencies of certain behaviours and delays between behaviours differed. Following immersion, blood pH was lower than normal. The low pH induced by the CO2/O2/air mixture was physiologically associated with hyperoxemia. Relationships between blood gases, different behavioural and heart rate responses are discussed. In conclusion, all mixtures caused discomfort due to respiratory difficulties and the addition of O2 or N2O to the CO2 mixture did not present an advantage.
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Affiliation(s)
- E M Claudia Terlouw
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, F-63122 Saint-Genès-Champanelle, France.
| | - Véronique Deiss
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, F-63122 Saint-Genès-Champanelle, France
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Escape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia. Anesth Analg 2019; 128:726-736. [PMID: 30883418 DOI: 10.1213/ane.0000000000004006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The question of how general anesthetics suppress consciousness has persisted since the mid-19th century, but it is only relatively recently that the field has turned its focus to a systematic understanding of emergence. Once assumed to be a purely passive process, spontaneously occurring as residual levels of anesthetics dwindle below a critical value, emergence from general anesthesia has been reconsidered as an active and controllable process. Emergence is driven by mechanisms that can be distinct from entry to the anesthetized state. In this narrative review, we focus on the burgeoning scientific understanding of anesthetic emergence, summarizing current knowledge of the neurotransmitter, neuromodulators, and neuronal groups that prime the brain as it prepares for its journey back from oblivion. We also review evidence for possible strategies that may actively bias the brain back toward the wakeful state.
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De Baerdemaeker A, Poelaert J, Kennedy RR, De Wolf AM, Hendrickx JFA. The effect of isocapnic hyperventilation on early recovery after remifentanil/sevoflurane anesthesia in O 2 /air: A randomized trial. Acta Anaesthesiol Scand 2019; 63:455-460. [PMID: 30397906 DOI: 10.1111/aas.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (ICHV) may hasten emergence from general anesthesia but remains inadequately studied. We prospectively determined emergence time after sevoflurane anesthesia of variable duration with and without ICHV. METHODS In 25 ASA I-II patients, general anesthesia was maintained with one age-adjusted MAC sevoflurane in O2 /air and target-controlled remifentanil delivery. At the start of skin closure, the remifentanil effect-site concentration was reduced to 1.5 ng/mL, any residual neuromuscular block reversed, and once the remifentanil effect-site concentration had decreased to 1.5 ng/mL, remifentanil and sevoflurane administration was stopped, and the fresh gas flow increased above minute ventilation. Patients randomly received either normoventilation (n = 13) or ICHV (doubling minute ventilation while titrating CO2 into the inspiratory limb to maintain isocapnia [n = 12]). Three early recovery end points were determined: time to proper response to verbal command; time to extubation; and time to stating one's name. RESULTS Demographics were the same in both groups. Recovery end points were reached faster in the ICHV group compared to the normoventilation group: time to proper response to verbal command was 7.6 ± 2.2 vs 9.9 ± 2.9 min (P = 0.03); time to extubation was 7.6 ± 2.6 vs 11.0 ± 2.4 min (P = 0.002); and time to stating one's name was 8.9 ± 2.8 vs 12.5 ± 2.6 min (P = 0.003). Within each group, duration of anesthesia only marginally affected the times to reach these recovery end points. CONCLUSION Isocapnic hyperventilation only had a small effect on emergence times after anesthesia, suggesting that isocapnic hyperventilation may have limited clinical benefits with modern potent inhaled anesthetics.
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Affiliation(s)
| | - Jan Poelaert
- Department of Anesthesiology, VUB; University Hospital Brussels; Jette Belgium
| | - R. Ross Kennedy
- Department of Anaesthesia; Christchurch Hospital and University of Otago, Christchurch; Christchurch New Zealand
| | - Andre M. De Wolf
- Department of Anesthesiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Hallén K, Jildenstål P, Stenqvist O, Oras J, Ricksten SE, Lindgren S. Isocapnic hyperventilation provides early extubation after head and neck surgery: A prospective randomized trial. Acta Anaesthesiol Scand 2018; 62:1064-1071. [PMID: 29671866 DOI: 10.1111/aas.13133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) shortens recovery time after inhalation anaesthesia by increasing ventilation while maintaining a normal airway carbon dioxide (CO2)-level. One way of performing IHV is to infuse CO2 to the inspiratory limb of a breathing circuit during mechanical hyperventilation (HV). In a prospective randomized study, we compared this IHV technique to a standard emergence procedure (control). METHODS Thirty-one adult ASA I-III patients undergoing long-duration (>3 hours) sevoflurane anaesthesia for major head and neck surgery were included and randomized to IHV-treatment (n = 16) or control (n = 15). IHV was performed at minute ventilation 13.6 ± 4.3 L/min and CO2 delivery, dosed according to a nomogram tested in a pilot study. Time to extubation and eye-opening was recorded. Inspired (FICO2) and expired (FETCO2) CO2 and arterial CO2 levels (PaCO2) were monitored. Cognition was tested preoperatively and at 20, 40 and 60 minutes after surgery. RESULTS Time from turning off the vapourizer to extubation was 13.7 ± 2.5 minutes in the IHV group and 27.4 ± 6.5 minutes in controls (P < .001). Two minutes after extubation, PaCO2 was 6.2 ± 0.5 and 6.2 ± 0.6 kPa in the IHV and control group respectively. In 69% (IHV) vs 53% (controls), post-operative cognition returned to pre-operative values within 40 minutes after surgery (NS). Incidences of pain and nausea/vomiting did not differ between groups. CONCLUSIONS In this randomized trial comparing an IHV method with a standard weaning procedure, time to extubation was reduced with 50% in the IHV group. The described IHV method can be used to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K Hallén
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - P Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - O Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - J Oras
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S-E Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Kwon KH, Bae H, Kang HG, In J. Hypercapnia does not shorten emergence time from propofol anesthesia: a pilot randomized clinical study. Korean J Anesthesiol 2018; 71:207-212. [PMID: 29690757 PMCID: PMC5995009 DOI: 10.4097/kja.d.18.27068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/29/2017] [Accepted: 11/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background The elimination of anesthetic agents is a decisive factor in the emergence from general anesthesia. In this pilot study, we hypothesized that hypercapnia would decrease the emergence time from propofol anesthesia by increasing cardiac output and cerebral blood flow. Methods A total of 32 patients were randomly divided into two groups based on the end-tidal carbon dioxide values: 30 mmHg (the hypocapnia group) and 50 mmHg (the hypercapnia group). Propofol and remifentanil were infused to maintain a bispectral index of 40–50. Remifentanil infusion was stopped 10 min before the discontinuation of propofol. After cessation of propofol infusion, ventilation settings in the hypocapnia group were maintained constant; a rebreathing tube was connected to the respiratory circuit in the hypercapnia group. The time to spontaneous respiration, eye opening (primary endpoint), mouth opening, and tracheal extubation was recorded and analyzed. Results Time to eye opening was 9.7 (1.3) min in the hypocapnia group and 9.0 (1.0) min in the hypercapnia group. The difference in the mean times to eye opening between groups was −0.7 min (95% CI, −4.0 to 2.7, P = 0.688). On multiple regression analysis, there was a significant difference in the mean time to eye opening between males and females. Females recovered about 3.6 min faster than males (95% CI, −6.1 to −1.1, P = 0.009). Conclusions We could not detect a beneficial effect of hypercapnia on propofol emergence time. Irrespective of hypercapnia, females seemed to recover faster than males.
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Affiliation(s)
- Ki-Hyug Kwon
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hansu Bae
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Gu Kang
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Hallén K, Jildenstål P, Stenqvist O, Ricksten SE, Lindgren S. Evaluation of a method for isocapnic hyperventilation: a clinical pilot trial. Acta Anaesthesiol Scand 2018; 62:186-195. [PMID: 29034967 DOI: 10.1111/aas.13008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO2 . In a clinical trial on patients undergoing long-duration sevoflurane anaesthesia for major ear-nose-throat (ENT) surgery, we evaluated the utility of a technique for CO2 delivery (DCO2 ) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia. METHODS Fifteen adult ASA 1-3 patients were included. After end of surgery, mechanical HV was started by doubling baseline minute ventilation. Simultaneously, CO2 was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO2 ) and expired (FETCO2 ) CO2 and arterial CO2 levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery. RESULTS A DCO2 of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO2 level was 3.0 ± 0.3%. Time from turning off the vaporizer (1.3 ± 0.1 MACage) to extubation (0.2 ± 0.1 MACage) was 11.3 ± 1.8 min after 342 ± 131 min of anaesthesia. PaCO2 and FETCO2 remained at normal levels during and after IHV. In 85% of the patients, post-operative cognition returned to pre-operative values within 60 min. CONCLUSIONS In this cohort of patients, a DCO2 nomogram for IHV was validated. The patients were safely extubated shortly after discontinuing long-term sevoflurane anaesthesia. Perioperatively, there were no adverse effects on arterial blood gases or post-operative cognition. This technique for IHV can potentially be used to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - P. Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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Kanaya A, Kuratani N, Nakata Y, Yamauchi M. Factors affecting extubation time following pediatric ambulatory surgery: an analysis using electronic anesthesia records from an academic university hospital. JA Clin Rep 2017; 3:38. [PMID: 29457082 PMCID: PMC5804621 DOI: 10.1186/s40981-017-0108-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background In pediatric general anesthesia, our goal should be quicker extubation to facilitate rapid turnover in the operating room without compromising on safety and quality of anesthesia. Although many studies have focused on improving safety and pursuing a higher quality of recovery, factors related to anesthesia emergence remain unclear. We must, therefore, identify factors that influence the process of emergence from general anesthesia in children. Findings We retrospectively examined 148 children (aged 1–6 years, American Society of Anesthesiologists physical status: 1–2) who had undergone <2 h of ambulatory surgery. Clinical measures included time from the end of surgery to extubation (extubation time), age, height, weight, surgical time, mean indirect blood pressure during surgery, mean heart rate during surgery, mean end-tidal carbon dioxide during surgery (mETCO2), mean body temperature during surgery (mBT), and total amount of fentanyl. Anesthetic procedures involved sevoflurane or propofol. Multiple regression analysis revealed that mETCO2 (p < 0.01) and mBT (p < 0.01) were independent clinical factors associated with extubation time following pediatric ambulatory surgery. Conclusions This study of 148 pediatric patients demonstrated that anesthesia emergence may be associated with mBT and mETCO2 following pediatric ambulatory surgery. These results show that perioperative vital signs are important in the prevention of delayed emergence for pediatric patients.
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Affiliation(s)
- Akihiro Kanaya
- 1Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Norifumi Kuratani
- 1Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan.,2Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshinori Nakata
- 3Department of Anesthesia, Teikyo University Hospital, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Masanori Yamauchi
- 1Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
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Hallén K, Stenqvist O, Ricksten SE, Lindgren S. Isocapnic hyperventilation shortens washout time for sevoflurane - an experimental in vivo study. Acta Anaesthesiol Scand 2016; 60:1261-9. [PMID: 27396945 DOI: 10.1111/aas.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) is a method that fastens weaning from inhalation anaesthesia by increasing airway concentration of carbon dioxide (CO2 ) during hyperventilation (HV). In an animal model, we evaluated a technique of adding CO2 directly to the breathing circuit of a standard anaesthesia apparatus. METHODS Eight anaesthetised pigs weighing 28 ± 2 kg were intubated and mechanically ventilated. From a baseline ventilation of 5 l/min, HV was achieved by doubling minute volume and fresh gas flow. Respiratory rate was increased from 15 to 22/min. The CO2 absorber was disconnected and CO2 was delivered (DCO2 ) to the inspiratory limb of a standard breathing circuit via a mixing box. Time required to decrease end-tidal sevoflurane concentration from 2.7% to 0.2% was defined as washout time. Respiration and haemodynamics were monitored by blood gas analysis, spirometry, electric impedance tomography and pulse contour analysis. RESULTS A DCO2 of 261 ± 19 ml/min was necessary to achieve isocapnia during HV. The corresponding FICO2 -level remained stable at 3.1 ± 0.3%. During IHV, washout of sevoflurane was three times faster, 433 ± 135 s vs. 1387 ± 204 s (P < 0.001). Arterial CO2 tension and end-tidal CO2 , was 5.2 ± 0.4 kPa and 5.6 ± 0.4%, respectively, before IHV and 5.1 ± 0.3 kPa and 5.7 ± 0.3%, respectively, during IHV. CONCLUSIONS In this experimental in vivo model of isocapnic hyperventilation, the washout time of sevoflurane anaesthesia was one-third compared to normal ventilation. The method for isocapnic hyperventilation described can potentially be transferred to a clinical setting with the intention to decrease emergence time from inhalation anaesthesia.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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Hallén K, Stenqvist O, Ricksten SE, Lindgren S. A simple method for isocapnic hyperventilation evaluated in a lung model. Acta Anaesthesiol Scand 2016; 60:597-606. [PMID: 26688296 DOI: 10.1111/aas.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isocapnic hyperventilation (IHV) has the potential to increase the elimination rate of anaesthetic gases and has been shown to shorten time to wake-up and post-operative recovery time after inhalation anaesthesia. In this bench test, we describe a technique to achieve isocapnia during hyperventilation (HV) by adding carbon dioxide (CO2) directly to the breathing circuit of a standard anaesthesia apparatus with standard monitoring equipment. METHODS Into a mechanical lung model, carbon dioxide was added to simulate a CO2 production (V(CO2)) of 175, 200 and 225 ml/min. Dead space (V(D)) volume could be set at 44, 92 and 134 ml. From baseline ventilation (BLV), HV was achieved by doubling the minute ventilation and fresh gas flow for each level of V(CO2), and dead space. During HV, CO2 was delivered (D(CO2)) by a precision flow meter via a mixing box to the inspiratory limb of the anaesthesia circuit to achieve isocapnia. RESULTS During HV, the alveolar ventilation increased by 113 ± 6%. Tidal volume increased by 20 ± 0.1% during IHV irrespective of V(D) and V(CO2) level. D(CO2) varied between 147 ± 8 and 325 ± 13 ml/min. Low V(CO2) and large V(D) demanded a greater D(CO2) administration to achieve isocapnia. The FICO2 level during IHV varied between 2.3% and 3.3%. CONCLUSION It is possible to maintain isocapnia during HV by delivering carbon dioxide through a standard anaesthesia circuit equipped with modern monitoring capacities. From alveolar ventilation, CO2 production and dead space, the amount of carbon dioxide that is needed to achieve IHV can be estimated.
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Affiliation(s)
- K. Hallén
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - O. Stenqvist
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - S. Lindgren
- Department of Anaesthesiology and Intensive Care medicine; Institution of Clinical Sciences; The Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
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Cheng Q, Zhang J, Wang H, Zhang R, Yue Y, Li L. Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications among Patients Receiving Bronchoscopic Interventions under General Anesthesia. PLoS One 2015; 10:e0130771. [PMID: 26147645 PMCID: PMC4492548 DOI: 10.1371/journal.pone.0130771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/23/2015] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to investigate the effect of acute hypercapnia on surgery outcomes among patients receiving bronchoscopic interventions under general anesthesia. Furthermore, independent predictive factors for surgery complications were analyzed. Method A total of 323 patients with airway stenosis were enrolled in this retrospective study. Each patient underwent interventional rigid bronchoscopy under general anesthesia. Arterial blood gas (ABG) was measured intraoperatively. In light of PaCO2 levels in ABG, patients were divided into three groups: Group C (control) (PaCO2:≤ 60 mmHg), Group M (moderate) (PaCO2:61–100 mmHg), and Group S (severe) (PaCO2: >100 mmHg). Parameters, including PaO2 levels and recovery delays, were compared across three groups. Complications among patients receiving bronchoscopic interventions were evaluated as well. Independent predictive factors for surgery related complications were analyzed by multivariable regression method. Results Significant differences in weight (p=0.04), ASA IV (p=0.008), dyspnea index (p=0.003),COPD (p=0.02), dynamic airway collapse (p=0.002), severe stenosis severity (p=0.02), and stenosis locations among three groups were observed. Mild (PaCO2:~60 mmHg) to moderate (PaCO2:60–100 mmHg) hypercapnia was not associated with delayed recovery, whereas severe hypercapnia (PaCO2:>100 mmHg) was associated with delayed recovery, as well as declined PaO2 (p=0.00) and elevated blood glucose levels (p=0.00). The complications of bronchoscopic interventions included postoperative congestive heart failure (14 cases, 4.3%), tracheorrhagia (8 cases, 2.5%), delayed recovery (19 cases, 5.9%), and transfers to ICU after surgery (10 cases, 3.1%). The multivariable regression analysis showed that procedure duration (p=0.003), lobectomy (p=0.007), dynamic airway collapse (p=0.01), severe bronchial stenosis (p=0.01) and hypercapnia (p=0.02) were independent predictive factors for surgery related complications. Conclusions Acute hypercapnia lower than 100 mmHg was not associated with detrimental consequences, whereas severe hypercapnia (PaCO2: >100 mmHg) was associated with lower levels of PaO2. Hypercapnia was an independent predictive factor for bronchoscopic intervention complication, which may help physicians to optimize the therapeutic choices.
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Affiliation(s)
- Qinghao Cheng
- Department of Anesthesiology, China Meitan General Hospital, Beijing 100028, China
| | - Jieli Zhang
- Minimal Invasive Tumor Therapy Center, China Meitan General Hospital, Beijing100028, China
| | - Hongwu Wang
- Minimal Invasive Tumor Therapy Center, China Meitan General Hospital, Beijing100028, China
| | - Rujin Zhang
- Department of Anesthesiology, Beijing United Family Hospital, Beijing 100015, China
| | - Yun Yue
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lei Li
- Department of Anesthesiology, China Meitan General Hospital, Beijing 100028, China
- * E-mail:
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Yaraghi A, Golparvar M, Talakoub R, Sateie H, Mehrabi A. Hypercapnic hyperventilation shortens emergence time from Propofol and Isoflurane anesthesia. J Res Pharm Pract 2014; 2:24-8. [PMID: 24991600 PMCID: PMC4076894 DOI: 10.4103/2279-042x.114085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: The aim of this study is to compare the effects of hypercapnic hyperventilation and normocapnic normoventilation on emergence time from propofol and isoflurane anesthesia. Methods: In this clinical trial, the differences in emergence time were evaluated in 80 patients undergoing elective abdominal surgery in Alzahra University hospital, Isfahan, Iran, in 2011-2012. Patients were randomly divided into four groups (groups 1-4) receiving isoflurane hypercapnic hyperventilation, isoflurane normocapnic normoventilation, propofol hypercapnic hyperventilation, and propofol normocapnic normoventilation, respectively. Hypercapnia was maintained by adding CO2 to the patient's inspired gas during hyperventilation. The emergence time and the duration of stay in recovery room in the four groups were measured and compared by one-way analysis of variance (ANOVA) and least significant difference tests. Findings: The average emergence time in groups 1, 2, 3, and 4 were (11.3 ± 3.2), (15.2 ± 3.8), (9 ± 4.2) and (11.8 ± 5.3) min, respectively. These differences were significant (P = 0.001). In patients receiving propofol hypercapnic hyperventilation, the emergence time was faster than in other groups. There was also a significant difference in duration of stay in recovery room between the groups (P = 0.004). Patients who received isoflurane hypercapnic hyperventilation had a shortest length of stay in the recovery room. Conclusion: The emergence time after intravenous anesthesia with propofol can be shortened significantly by using hyperventilation and hypercapnia, without any side effects.
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Affiliation(s)
- Ahmad Yaraghi
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Golparvar
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihanak Talakoub
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Sateie
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mehrabi
- Department of Anesthesia and Critical Care, Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Saghaei M, Matin G, Golparvar M. Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial. Adv Biomed Res 2014; 3:84. [PMID: 24761392 PMCID: PMC3988596 DOI: 10.4103/2277-9175.127997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/10/2013] [Indexed: 12/22/2022] Open
Abstract
Background: A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide (ETCO2). It is probable that hypercapnia may exert its beneficial effects on patients’ outcome through optimization of global hemodynamic and tissue oxygenation, leading to a lower rate of post-operative complications. This study was designed to test the hypothesis that higher values of intra-operative ETCO2 decrease the rate of post-operative complications. Materials and Methods: In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy (PCNL) were prospectively enrolled and randomly divided into three groups. ETCO2 was set and maintained throughout the procedure at 31-33, 37-39 and 43-45 mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups. Results: Seventy-five patients completed the study (52 male and 23 female). Ten (38.5%), four (16%) and two (8.3%) patients developed post-operative vomiting in the hypocapnia, normocapnia and hypercapnia groups, respectively (P = 0.025). The nausea score was significantly lower in the hypercapnic group compared with the other groups (3.9 ± 1.8, 3.2 ± 2.1 and 1.3 ± 1.8 in the hypocapnia, normocapnia and hypercapnia groups, respectively; P = 0.000). Time to return of spontaneous respiration and awakening were significantly decreased in the hypercapnia group compared with the other groups (P < 0.01). Conclusion: Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia.
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Affiliation(s)
- Mahmoud Saghaei
- Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Matin
- Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Golparvar
- Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran
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KATZNELSON R, DJAIANI G, NAUGHTON F, WASOWICZ M, RAGOONANAN T, DUFFIN J, FEDORKO L, MURPHY J, FISHER JA. Post-operative hypercapnia-induced hyperpnoea accelerates recovery from sevoflurane anaesthesia: a prospective randomised controlled trial. Acta Anaesthesiol Scand 2013; 57:623-30. [PMID: 23452265 DOI: 10.1111/aas.12093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The time to recovery from vapour anaesthesia is shortened by an increase in ventilation while maintaining normocapnia. Hypercapnia during emergence from anaesthesia in spontaneously breathing patients also increases anaesthetic clearance from the brain by increasing cerebral blood flow. We hypothesised that hypercapnia-induced hyperpnoea accelerates emergence from sevoflurane anaesthesia compared to the standard anaesthesia protocol. METHODS After Ethics Review Board approval, 44 ASA I-III patients undergoing elective gynaecological surgery were randomised after surgery to either hypercapnic hyperpnoea or control groups. In the hypercapnic hyperpnoea group, the end-tidal CO2 was adjusted to a range of 6.0-7.3 kPa to maintain a minute ventilation of 10-15 l/min. Recovery indices were compared using unpaired t-tests and ANOVA. RESULTS Prior to extubation, minute ventilation and end-tidal CO2 in hypercapnic hyperpnoea and control groups were 10.3 ± 1.7 l/min vs. 5.4 ± 1.2 l/min (P < 0.001) and 6.6 ± 0.6 kPa and 5.2 ± 0.5 kPa (P < 0.001), respectively. Compared to control, the study group had shorter time to extubation [4.4 ± 1.3 (SD) vs. 9.8 ± 4.4 min, P < 0.01], BIS recovery to > 75 (2.4 ± 0.9 vs. 6.1 ± 3.1 min, P < 0.01), eye opening (3.9 ± 1.6 vs. 9.8 ± 6.2 min, P < 0.01), eligibility for leaving operating room (5.1 ± 1.2 vs. 11.1 ± 4.6 min, P < 0.01), and post-anaesthesia care unit (73.9 ± 14.2 vs. 89.4 ± 22.6) CONCLUSION Hypercapnic hyperpnoea in spontaneously breathing patients halves the time of recovery from sevoflurane-induced anaesthesia in the operating room.
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Affiliation(s)
- R. KATZNELSON
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - G. DJAIANI
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - F. NAUGHTON
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - M. WASOWICZ
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - T. RAGOONANAN
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - J. DUFFIN
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - L. FEDORKO
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - J. MURPHY
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
| | - J. A. FISHER
- Department of Anesthesia and Pain Management; University Health Network; University of Toronto; Toronto; ON; Canada
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Mild hypercapnia with hyperventilation attenuates recovery from anesthesia in elderly patients. J Anesth 2013; 27:712-9. [DOI: 10.1007/s00540-013-1617-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
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De Wolf AM, Van Zundert TC, De Cooman S, Hendrickx JF. Theoretical effect of hyperventilation on speed of recovery and risk of rehypnotization following recovery - a GasMan® simulation. BMC Anesthesiol 2012; 12:22. [PMID: 22989260 PMCID: PMC3502091 DOI: 10.1186/1471-2253-12-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022] Open
Abstract
Background Hyperventilation may be used to hasten recovery from general anesthesia with potent inhaled anesthetics. However, its effect may be less pronounced with the newer, less soluble agents, and it may result in rehypnotization if subsequent hypoventilation occurs because more residual anesthetic will be available in the body for redistribution to the central nervous system. We used GasMan® simulations to examine these issues. Methods One MAC of isoflurane, sevoflurane, or desflurane was administered to a fictitious 70 kg patient for 8 h with normoventilation (alveolar minute ventilation [VA] 5 L.min-1), resulting in full saturation of the vessel rich group (VRG) and >95% saturation of the muscle group. After 8 h, agent administration was stopped, and fresh gas flow was increased to 10 L.min-1 to avoid rebreathing. At that same time, we continued with one simulation where normoventilation was maintained, while in a second simulation hyperventilation was instituted (10 L.min-1). We determined the time needed for the partial pressure in the VRG (FVRG; representing the central nervous system) to reach 0.3 MAC (MACawake). After reaching MACawake in the VRG, several degrees of hypoventilation were instituted (VA of 2.5, 1.5, 1, and 0.5 L.min-1) to determine whether FVRG would increase above 0.3 MAC(= rehypnotization). Results Time to reach 0.3 MAC in the VRG with normoventilation was 14 min 42 s with isoflurane, 9 min 12 s with sevoflurane, and 6 min 12 s with desflurane. Hyperventilation reduced these recovery times by 30, 18, and 13% for isoflurane, sevoflurane, and desflurane, respectively. Rehypnotization was observed with VA of 0.5 L.min-1 with desflurane, 0.5 and 1 L.min-1 with sevoflurane, and 0.5, 1, 1.5, and 2.5 L.min-1 with isoflurane. Only with isoflurane did initial hyperventilation slightly increase the risk of rehypnotization. Conclusions These GasMan® simulations confirm that the use of hyperventilation to hasten recovery is marginally beneficial with the newer, less soluble agents. In addition, subsequent hypoventilation results in rehypnotization only with more soluble agents, unless hypoventilation is severe. Also, initial hyperventilation does not increase the risk of rehypnotization with less soluble agents when subsequent hypoventilation occurs. Well-controlled clinical studies are required to validate these simulations.
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Affiliation(s)
- Andre M De Wolf
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University Medical School, 251 East Huron, Chicago, IL, 60611-3053, USA.
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Ogden LL, Mobley S. A rapid emergence device to aid recovery from a volatile anesthetic in stage II nasal reconstruction repair. J Clin Anesth 2012; 24:428-9. [PMID: 22626680 DOI: 10.1016/j.jclinane.2011.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 06/06/2011] [Accepted: 07/04/2011] [Indexed: 11/16/2022]
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Brosnan RJ, Steffey EP, Escobar A. Effects of hypercapnic hyperpnea on recovery from isoflurane or sevoflurane anesthesia in horses. Vet Anaesth Analg 2012; 39:335-44. [PMID: 22574839 DOI: 10.1111/j.1467-2995.2012.00727.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the hypothesis that hypercapnic hyperpnea produced using endotracheal insufflation with 5-10% CO(2) in oxygen could be used to shorten anesthetic recovery time in horses, and that recovery from sevoflurane would be faster than from isoflurane. STUDY DESIGN Randomized crossover study design. ANIMALS Eight healthy adult horses. METHODS After 2 hours' administration of constant 1.2 times MAC isoflurane or sevoflurane, horses were disconnected from the anesthetic circuit and administered 0, 5, or 10% CO(2) in balance O(2) via endotracheal tube insufflation. End-tidal gas samples were collected to measure anesthetic washout kinetics, and arterial and venous blood samples were collected to measure respiratory gas partial pressures. Horses recovered in padded stalls without assistance, and each recovery was videotaped and evaluated by reviewers who were blinded to the anesthetic agent and insufflation treatment used. RESULTS Compared to isoflurane, sevoflurane caused greater hypoventilation and was associated with longer times until standing recovery. CO(2) insufflation significantly decreased anesthetic recovery time compared to insufflation with O(2) alone without significantly increasing PaCO(2) . Pharmacokinetic parameters during recovery from isoflurane with CO(2) insufflation were statistically indistinguishable from sevoflurane recovery without CO(2). Neither anesthetic agent nor insufflation treatment affected recovery quality from anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE Hypercapnic hyperpnea decreases time to standing without influencing anesthetic recovery quality. Although the lower blood gas solubility of sevoflurane should favor a shorter recovery time compared to isoflurane, this advantage is negated by the greater respiratory depression from sevoflurane in horses.
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Affiliation(s)
- Robert J Brosnan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.
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Katznelson R, Van Rensburg A, Friedman Z, Wasowicz M, Djaiani GN, Fedorko L, Minkovich L, Fisher JA. Isocapnic hyperpnoea shortens postanesthetic care unit stay after isoflurane anesthesia. Anesth Analg 2010; 111:403-8. [PMID: 20495141 DOI: 10.1213/ane.0b013e3181e2475c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We conducted a prospective controlled clinical trial of the effect of isocapnic hyperpnoea (IH) on the times-to-recovery milestones in the operating room (OR) and postanesthetic care unit (PACU) after 1.5 to 3 hours of isoflurane anesthesia. METHODS Thirty ASA grade I-III patients undergoing elective gynecological surgery were randomized at the end of surgery to either IH or the conventional recovery (control). Six patients with duration of anesthesia of <90 minutes were excluded from the analysis. The anesthesia protocol included propofol, fentanyl, morphine, rocuronium, and isoflurane in air/O(2). Unpaired t tests and analyses of variance were used to test for differences in times-to-recovery indicators between the two groups. RESULTS The durations of anesthesia in IH and control groups were 140.8 + or - 32.7 and 142 + or - 55.6 minutes, respectively (P = 0.99). The time to extubation was much shorter in the IH group than in the control group (6.6 + or - 1.6 (SD) vs. 13. 6 + or - 3.9 minutes, respectively; P < 0.01). The IH group also had shorter times to eye opening (5.8 + or - 1.3 vs. 13.7 + or - 4.5 minutes; P < 0.01), eligibility for leaving the OR (8.0 + or - 1.7 vs. 17.4 + or - 6.1 minutes; P < 0.01), and eligibility for PACU discharge (74.0 + or - 16.5 vs. 94.5 + or - 14.7 minutes; P < 0.01). There were no differences in other indicators of recovery. CONCLUSION IH accelerates recovery after 1.5 to 3 hours of isoflurane anesthesia and shortens OR and PACU stay.
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Affiliation(s)
- Rita Katznelson
- Department of Anesthesia, Toronto General Hospital, Eaton North 3-453, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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