Isocapnic hyperventilation provides early extubation after head and neck surgery : A prospective randomized trial
(2018) In Acta Anaesthesiologica Scandinavica 62(8). p.1064-1071- 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... (More)
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.
(Less)
- author
- Hallén, K. ; Jildenstål, P. LU ; Stenqvist, O. ; Oras, J. ; Ricksten, S. E. and Lindgren, S.
- publishing date
- 2018-09-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- anaesthesia recovery period, carbon dioxide, hyperventilation, inhalation anaesthetics, sevoflurane, ventilators
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 62
- issue
- 8
- pages
- 8 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85045844290
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.13133
- language
- English
- LU publication?
- no
- id
- f5bc803e-b1ce-44cc-b1c7-93906309a411
- date added to LUP
- 2020-09-27 20:46:02
- date last changed
- 2022-04-19 01:10:58
@article{f5bc803e-b1ce-44cc-b1c7-93906309a411,
abstract = {{<p>Background: Isocapnic hyperventilation (IHV) shortens recovery time after inhalation anaesthesia by increasing ventilation while maintaining a normal airway carbon dioxide (CO<sub>2</sub>)-level. One way of performing IHV is to infuse CO<sub>2</sub> 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 CO<sub>2</sub> delivery, dosed according to a nomogram tested in a pilot 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 (PaCO<sub>2</sub>) 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, PaCO<sub>2</sub> 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.</p>}},
author = {{Hallén, K. and Jildenstål, P. and Stenqvist, O. and Oras, J. and Ricksten, S. E. and Lindgren, S.}},
issn = {{0001-5172}},
keywords = {{anaesthesia recovery period; carbon dioxide; hyperventilation; inhalation anaesthetics; sevoflurane; ventilators}},
language = {{eng}},
month = {{09}},
number = {{8}},
pages = {{1064--1071}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Anaesthesiologica Scandinavica}},
title = {{Isocapnic hyperventilation provides early extubation after head and neck surgery : A prospective randomized trial}},
url = {{http://dx.doi.org/10.1111/aas.13133}},
doi = {{10.1111/aas.13133}},
volume = {{62}},
year = {{2018}},
}