Evaluation of a method for isocapnic hyperventilation : a clinical pilot trial
(2018) In Acta Anaesthesiologica Scandinavica 62(2). p.186-195- Abstract
Background: Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO 2 . 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 CO 2 delivery (DCO 2 ) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia. Methods: Fifteen adult ASA 1–3 patients were included. After... (More)
Background: Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO 2 . 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 CO 2 delivery (DCO 2 ) 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, CO 2 was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO 2 ) and expired (FETCO 2 ) CO 2 and arterial CO 2 levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery. Results: A DCO 2 of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO 2 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. PaCO 2 and FETCO 2 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 DCO 2 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.
(Less)
- author
- Hallén, K. ; Jildenstål, P. LU ; Stenqvist, O. ; Ricksten, S. E. and Lindgren, S.
- publishing date
- 2018-02-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 62
- issue
- 2
- pages
- 10 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:29034967
- scopus:85040314867
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.13008
- language
- English
- LU publication?
- no
- id
- 585b2e7f-7fcb-405e-8ac3-70d060008bfb
- date added to LUP
- 2020-09-27 20:48:01
- date last changed
- 2024-04-17 17:05:32
@article{585b2e7f-7fcb-405e-8ac3-70d060008bfb,
abstract = {{<p> Background: Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO <sub>2</sub> . 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 CO <sub>2</sub> delivery (DCO <sub>2</sub> ) 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, CO <sub>2</sub> was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO <sub>2</sub> ) and expired (FETCO <sub>2</sub> ) CO <sub>2</sub> and arterial CO <sub>2</sub> levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery. Results: A DCO <sub>2</sub> of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO <sub>2</sub> 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. PaCO <sub>2</sub> and FETCO <sub>2</sub> 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 DCO <sub>2</sub> 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. </p>}},
author = {{Hallén, K. and Jildenstål, P. and Stenqvist, O. and Ricksten, S. E. and Lindgren, S.}},
issn = {{0001-5172}},
language = {{eng}},
month = {{02}},
number = {{2}},
pages = {{186--195}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Anaesthesiologica Scandinavica}},
title = {{Evaluation of a method for isocapnic hyperventilation : a clinical pilot trial}},
url = {{http://dx.doi.org/10.1111/aas.13008}},
doi = {{10.1111/aas.13008}},
volume = {{62}},
year = {{2018}},
}