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Isocapnic hyperventilation shortens washout time for sevoflurane - an experimental in vivo study

Artikel i vetenskaplig tidskrift
Författare Katarina Hallén
Ola Stenqvist
Sven-Erik Ricksten
Sophie Lindgren
Publicerad i Acta Anaesthesiologica Scandinavica
Volym 60
Nummer/häfte 9
Sidor 1261-1269
ISSN 0001-5172
Publiceringsår 2016
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård
Sidor 1261-1269
Språk en
Länkar dx.doi.org/10.1111/aas.12761
Ämnesord hyperpnea accelerates recovery, electric impedance tomography, isoflurane anesthesia, clinical-evaluation, emergence time, carbon-dioxide, hypercapnia, pigs, ventilation, monitor
Ämneskategorier Klinisk medicin

Sammanfattning

BackgroundIsocapnic hyperventilation (IHV) is a method that fastens weaning from inhalation anaesthesia by increasing airway concentration of carbon dioxide (CO2) during hyperventilation (HV). In an animal model, we evaluated a technique of adding CO2 directly to the breathing circuit of a standard anaesthesia apparatus. MethodsEight anaesthetised pigs weighing 28 2 kg were intubated and mechanically ventilated. From a baseline ventilation of 5 l/min, HV was achieved by doubling minute volume and fresh gas flow. Respiratory rate was increased from 15 to 22/min. The CO2 absorber was disconnected and CO2 was delivered (DCO2) to the inspiratory limb of a standard breathing circuit via a mixing box. Time required to decrease end-tidal sevoflurane concentration from 2.7% to 0.2% was defined as washout time. Respiration and haemodynamics were monitored by blood gas analysis, spirometry, electric impedance tomography and pulse contour analysis. ResultsA DCO2 of 261 +/- 19 ml/min was necessary to achieve isocapnia during HV. The corresponding FICO2-level remained stable at 3.1 +/- 0.3%. During IHV, washout of sevoflurane was three times faster, 433 +/- 135 s vs. 1387 +/- 204 s (P < 0.001). Arterial CO2 tension and end-tidal CO2, was 5.2 +/- 0.4 kPa and 5.6 +/- 0.4%, respectively, before IHV and 5.1 +/- 0.3 kPa and 5.7 +/- 0.3%, respectively, during IHV. ConclusionsIn this experimental in vivo model of isocapnic hyperventilation, the washout time of sevoflurane anaesthesia was one-third compared to normal ventilation. The method for isocapnic hyperventilation described can potentially be transferred to a clinical setting with the intention to decrease emergence time from inhalation anaesthesia.

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