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Post‐operative hypercapnia‐induced hyperpnoea accelerates recovery from sevoflurane anaesthesia: a prospective randomised controlled trial
Author(s) -
KATZNELSON R.,
DJAIANI G.,
NAUGHTON F.,
WASOWICZ M.,
RAGOONANAN T.,
DUFFIN J.,
FEDORKO L.,
MURPHY J.,
FISHER J. A.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12093
Subject(s) - hypercapnia , medicine , normocapnia , anesthesia , sevoflurane , ventilation (architecture) , american society of anesthesiologists , tidal volume , respiratory system , acidosis , mechanical engineering , engineering
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 CO 2 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 CO 2 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.