Evaluation of a method for isocapnic hyperventilation: a clinical pilot trial

K. Hallén, P. Jildenstål, O. Stenqvist, S. E. Ricksten, S. Lindgren

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review

2 Citeringar (SciVal)


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.

Sidor (från-till)186-195
Antal sidor10
TidskriftActa Anaesthesiologica Scandinavica
StatusPublished - 2018 feb. 1
Externt publiceradJa

Ämnesklassifikation (UKÄ)

  • Anestesi och intensivvård


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