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Anesth Analg 2001;93:1277-1280
© 2001 International Anesthesia Research Society

NEUROSURGICAL ANESTHESIA

Voluntary Hyperventilation Before a Rapid-Sequence Induction of Anesthesia Does Not Decrease Postintubation PaCO2

André Choinière, MD, François Girard, MD FRCPC, Daniel Boudreault, MD FRCPC, Monique Ruel, RN, and Dominique C. Girard, MD FRCPC

Department of Anesthesiology, CHUM, Hôpital Notre-Dame, Montreal, Canada

Address correspondence and reprint requests to François Girard, MD, FRCPC, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, Canada, H2L 4M1.

To prevent hypercapnia, voluntary hyperventilation is recommended for patients with increased intracranial pressure before the induction of general anesthesia. We sought to determine whether this maneuver results in a lower PaCO2 than breathing 3 min of oxygen 100% by face mask (preoxygenation) after intubation. Thirty patients requiring general anesthesia were randomly assigned to breathe either 3 min of oxygen 100% by face mask (Group P) or 1 min of oxygen 100% followed by 2 min of voluntary hyperventilation with oxygen 100% (Group H). All patients received a standard rapid-sequence induction of anesthesia followed by a 90-s period of apnea. Patients were then tracheally intubated and mechanically ventilated. Five arterial blood gas samples were taken: with room air, after preoxygen- ation or hyperventilation, after 60 and 90 s of apnea, and after tracheal intubation. Voluntary hyperventilation decreased PaCO2 before rapid-sequence induction (hyperventilation, 30.0 ± 3.5 mm Hg versus preoxygenation, 37.9 ± 5.2 mm Hg; P < 0.0001), but after 60 s of apnea, both groups had similar PaCO2 (hyperventilation, 36.1 ± 3.3 mm Hg versus preoxygenation, 35.6 ± 3.4 mm Hg; P = 0.673), and no benefit was found after intubation (hyperventilation, 40.5 ± 3.9 mm Hg versus preoxygenation, 41.4 ± 2.7 mm Hg; P = 0.603). We conclude that voluntary hyperventilation before rapid-sequence induction does not provide protection against potential hypercapnia during intubation.

IMPLICATIONS: Voluntary hyperventilation before anesthesia induction is recommended for patients with increased intracranial pressure to prevent hypercapnia. This randomized, prospective study demonstrated that this maneuver does not result in a lower postintubation PaCO2 than standard preoxygenation.






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 © 2001 by the International Anesthesia Research Society.