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 Induced Hypercarbia During Emergence from Inhalation Anesthesia
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Anesth Analg 2007;104:815-821
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000255199.43961.87

ANESTHETIC PHARMACOLOGY

Hypercapnia Shortens Emergence Time from Inhaled Anesthesia in Pigs

Nishant A. Gopalakrishnan, PhD, Derek J. Sakata, MD, Joseph A. Orr, PhD, Scott McJames, MS, and Dwayne R. Westenskow, PhD

From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah.

Address correspondence to Nishant A. Gopalakrishnan, BS, University of Utah, Department of Anesthesiology, 30 N. 1900 East, 3C444 SOM, Salt Lake City, UT 84132. Address e-mail to nishant{at}abl.med.utah.edu.

BACKGROUND: Anesthetic clearance from the lungs and the circle rebreathing system can be maximized using hyperventilation and high fresh gas flows. However, the concomitant clearance of CO2 decreases PAco2, thereby decreasing cerebral blood flow and slowing the clearance of anesthetic from the brain. This study shows that in addition to hyperventilation, hypercapnia (CO2 infusion or rebreathing) is a significant factor in decreasing emergence time from inhaled anesthesia.

METHODS: We anesthetized seven pigs with 2 MACPIG of isoflurane and four with 2 MACPIG of sevoflurane. After 2 h, anesthesia was discontinued, and the animals were hyperventilated. The time to movement of multiple limbs was measured under hypocapnic (end-tidal CO2 = 22 mm Hg) and hypercapnic (end-tidal CO2 = 55 mm Hg) conditions.

RESULTS: The time between turning off the vaporizer and to movement of multiple limbs was faster with hypercapnia during hyperventilation. Emergence time from isoflurane and sevoflurane anesthesia was shortened by an average of 65% with rebreathing or with the use of a CO2 controller (P < 0.05).

CONCLUSIONS: Hypercapnia, along with hyperventilation, may be used clinically to decrease emergence time from inhaled anesthesia. These time savings might reduce drug costs. In addition, higher PAco2 during emergence may enhance respiratory drive and airway protection after tracheal extubation.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.