| Hypercapnic hyperventilation shortens emergence time from isoflurane anesthesia. | |
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MedLine Citation:
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PMID: 17312214 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To shorten emergence time after a procedure using volatile anesthesia, 78% of anesthesiologists recently surveyed used hyperventilation to rapidly clear the anesthetic from the lungs. Hyperventilation has not been universally adapted into clinical practice because it also decreases the Paco2, which decreases cerebral bloodflow and depresses respiratory drive. Adding deadspace to the patient's airway may be a simple and safe method of maintaining a normal or slightly increased Paco2 during hyperventilation. METHODS: We evaluated the differences in emergence time in 20 surgical patients undergoing 1 MAC of isoflurane under mild hypocapnia (ETco2 approximately 28 mmHg) and mild hypercapnia (ETco2 approximately 55 mmHg). The minute ventilation in half the patients was doubled during emergence, and hypercapnia was maintained by insertion of additional airway deadspace to keep the ETco2 close to 55 mmHg during hyperventilation. A charcoal canister adsorbed the volatile anesthetic from the deadspace. Fresh gas flows were increased to 10 L/min during emergence in all patients. RESULTS: The time between turning off the vaporizer and the time when the patients opened their eyes and mouths, the time of tracheal extubation, and the time for normalized bispectral index to increase to 0.95 were faster whenever hypercapnic hyperventilation was maintained using rebreathing and anesthetic adsorption (P < 0.001). The time to tracheal extubation was shortened by an average of 59%. CONCLUSIONS: The emergence time after isoflurane anesthesia can be shortened significantly by using hyperventilation to rapidly clear the anesthetic from the lungs and CO2 rebreathing to induce hypercapnia during hyperventilation. The device should be considered when it is important to provide a rapid emergence, especially after surgical procedures where a high concentration of the volatile anesthetic was maintained right up to the end of the procedure, or where surgery ends abruptly and without warning. |
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Authors:
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Derek J Sakata; Nishant A Gopalakrishnan; Joseph A Orr; Julia L White; Dwayne R Westenskow |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 104 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2007 Mar |
Date Detail:
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Created Date: 2007-02-21 Completed Date: 2007-03-27 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 587-91 Citation Subset: AIM; IM |
Affiliation:
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Departmentof Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA. Derek.Sakata@hsc.utah.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anesthesia Recovery Period* Anesthesia, Inhalation / instrumentation, methods* Anesthesiology / methods* Carbon Dioxide / metabolism Female Humans Hypercapnia / chemically induced Hyperventilation / physiopathology* Isoflurane / pharmacology* Lung / drug effects Male Respiration / drug effects Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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GM072661/GM/NIGMS NIH HHS |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 26675-46-7/Isoflurane |
| Comments/Corrections | |
Comment In:
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Anesth Analg. 2007 Mar;104(3):479-80
[PMID:
17312189
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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