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ANESTHETIC PHARMACOLOGY

Accelerated Recovery from Sevoflurane Anesthesia with Isocapnic Hyperpnoea

Rita Katznelson, MD^*, Leonid Minkovich, MD, PhD^*, Zeev Friedman, MD, Ludvik Fedorko, MD, PhD, FRCPC^*, W. Scott Beattie, MD, PhD, FRCPC^*, and Joseph A. Fisher, MD, FRCP(C)^*

From the *Department of Anesthesia, Toronto General Hospital, and Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Ontario.

Address correspondence and reprint requests to Rita Katznelson, MD, Department of Anesthesiology, Toronto General Hospital, Eaton North 3-453, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada. Address e-mail to rita.katznelson{at}uhn.on.ca.

BACKGROUND: Isocapnic hyperpnoea (IH) reduces recovery time from isoflurane anesthesia in animals and humans. We studied the effect of IH on the emergence profile of sevoflurane-anesthetized patients by comparing postoperative recovery variables in patients administered IH (IH group) to those recovered in the customary fashion (control group).

METHODS: We enrolled 30 ASA I–III patients undergoing elective gynecological surgery. Induction and maintenance of anesthesia were standardized with a protocol consisting of fentanyl, propofol, rocuronium, and sevoflurane in air/O₂. Patients were randomly assigned to control (C) or IH groups at the end of the surgery. We recorded time intervals from discontinuing sevoflurane to recovery milestones.

RESULTS: Time to tracheal extubation was much shorter in the IH group compared with group C (6.2 ± 2.1 vs 12.3 ± 3.8 min, respectively, P < 0.01). The IH group also had shorter times to initiation of spontaneous ventilation (4.2 ± 1.7 vs 6.5 ± 3.8 min, P = 0.047), eye opening (5.5 ± 1.4 vs 13.3 ± 4.4 min, P < 0.01), bispectral index value >75 (3.9 ± 1.1 vs 8.8 ± 3.7 min, P < 0.01), leaving operating room (7.7 ± 2.0 vs 15.3 ± 3.4 min, P < 0.01), and eligibility for postanesthetic care unit discharge (67.2 ± 19.3 vs 90.6 ± 20.0 min, P < 0.01).

CONCLUSION: IH accelerates recovery from sevoflurane anesthesia and shortens operating room and postanesthetic care unit stay.