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Jouwena J, Eerlings SA, De Wolf AM, Van Hoovels L, Neyrinck A, Van de Velde M, Hendrickx JFA. Arterial to end-tidal CO 2 gradients during isocapnic hyperventilation. J Clin Monit Comput 2023; 37:311-317. [PMID: 35896757 DOI: 10.1007/s10877-022-00893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/04/2022] [Indexed: 01/24/2023]
Abstract
Isocapnic hyperventilation (ICHV) is occasionally used to maintain the end-expired CO2 partial pressure (PETCO2) when the inspired CO2 (PICO2) rises. Whether maintaining PETCO2 with ICHV during an increase of the PICO2 also maintains arterial PCO2 (PaCO2) remains poorly documented. 12 ASA PS I-II subjects undergoing a robot-assisted radical prostatectomy (RARP) (n = 11) or cystectomy (n = 1) under general endotracheal anesthesia with sevoflurane in O2/air (40% inspired O2) were enrolled. PICO2 was sequentially increased from 0 to 0.5, 1.0, 1.5 and 2% by adding CO2 to the inspiratory limb of the circle system, while increasing ventilation to a target PETCO2 of 4.7-4.9% by adjusting respiratory rate during controlled mechanical ventilation. Pa-ETCO2 gradients were determined after a 15 min equilibration period at each PICO2 level and compared using ANOVA. Mean (standard deviation) age, height, and weight were 66 (6) years, 171 (6) cm, and 75 (8) kg, respectively. Capnograms were normal and hemodynamic parameters remained stable. PETCO2 could be maintained within 4.7-4.9% in all subjects at all times except in 1 subject with 1.5% PICO2 and 5 subjects with 2.0% PICO2; data from the one subject in whom both 1.5 and 2.0% PICO2 resulted in PETCO2 > 5.1% were excluded from analysis. Pa-ETCO2 gradients did not change when PICO2 increased. The effect of a modest rise of PICO2 up to 1.5% on PETCO2 during RARP can be readily overcome by increasing ventilation without altering the Pa-ETCO2 gradients. At higher PICO2, airway pressures may become a limiting factor, which requires further study.
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Affiliation(s)
- Jennifer Jouwena
- Department of Anesthesiology, OLV Hospital, Aalst, Belgium. .,Department of Anesthesiology, UZLeuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium.
| | - Sarah A Eerlings
- Department of Anesthesiology, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, UZLeuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - Andre M De Wolf
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Arne Neyrinck
- Department of Anesthesiology, UZLeuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - Marc Van de Velde
- Department of Anesthesiology, UZLeuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - Jan F A Hendrickx
- Department of Anesthesiology, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, UZLeuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium.,Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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Lindgren S, Hallén K, Ricksten SE, Stenqvist O. Comment on De Baerdemaeker et al. Acta Anaesthesiol Scand 2019; 63:833-834. [PMID: 30847893 DOI: 10.1111/aas.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katarina Hallén
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ola Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Hallén K, Jildenstål P, Stenqvist O, Oras J, Ricksten SE, Lindgren S. Isocapnic hyperventilation provides early extubation after head and neck surgery: A prospective randomized trial. Acta Anaesthesiol Scand 2018; 62:1064-1071. [PMID: 29671866 DOI: 10.1111/aas.13133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/19/2022]
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 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.
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Affiliation(s)
- K Hallén
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - P Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - O Stenqvist
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - J Oras
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S-E Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - S Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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