术后高碳酸血症诱导的通气过度加速七氟醚麻醉苏醒：一项前瞻性随机对照试验。

Post-operative hypercapnia-induced hyperpnoea accelerates recovery from sevoflurane anaesthesia: a prospective randomised controlled trial.

机构信息

Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.

出版信息

Acta Anaesthesiol Scand. 2013 May;57(5):623-30. doi: 10.1111/aas.12093. Epub 2013 Mar 3.

DOI:10.1111/aas.12093

PMID:23452265

Abstract

BACKGROUND

The time to recovery from vapour anaesthesia is shortened by an increase in ventilation while maintaining normocapnia. Hypercapnia during emergence from anaesthesia in spontaneously breathing patients also increases anaesthetic clearance from the brain by increasing cerebral blood flow. We hypothesised that hypercapnia-induced hyperpnoea accelerates emergence from sevoflurane anaesthesia compared to the standard anaesthesia protocol.

METHODS

After Ethics Review Board approval, 44 ASA I-III patients undergoing elective gynaecological surgery were randomised after surgery to either hypercapnic hyperpnoea or control groups. In the hypercapnic hyperpnoea group, the end-tidal CO2 was adjusted to a range of 6.0-7.3 kPa to maintain a minute ventilation of 10-15 l/min. Recovery indices were compared using unpaired t-tests and ANOVA.

RESULTS

Prior to extubation, minute ventilation and end-tidal CO2 in hypercapnic hyperpnoea and control groups were 10.3 ± 1.7 l/min vs. 5.4 ± 1.2 l/min (P < 0.001) and 6.6 ± 0.6 kPa and 5.2 ± 0.5 kPa (P < 0.001), respectively. Compared to control, the study group had shorter time to extubation [4.4 ± 1.3 (SD) vs. 9.8 ± 4.4 min, P < 0.01], BIS recovery to > 75 (2.4 ± 0.9 vs. 6.1 ± 3.1 min, P < 0.01), eye opening (3.9 ± 1.6 vs. 9.8 ± 6.2 min, P < 0.01), eligibility for leaving operating room (5.1 ± 1.2 vs. 11.1 ± 4.6 min, P < 0.01), and post-anaesthesia care unit (73.9 ± 14.2 vs. 89.4 ± 22.6)

CONCLUSION

Hypercapnic hyperpnoea in spontaneously breathing patients halves the time of recovery from sevoflurane-induced anaesthesia in the operating room.

摘要

背景

在自主呼吸患者从麻醉中苏醒时，增加二氧化碳分压（PaCO2）会通过增加脑血流来加速麻醉药物从大脑中的清除，从而缩短恢复时间。我们假设与标准麻醉方案相比，高碳酸血症诱导的通气过度会加速七氟醚麻醉的苏醒。

方法

在伦理审查委员会批准后，44 名接受择期妇科手术的 ASA I-III 级患者在手术后被随机分为高碳酸血症通气过度组或对照组。在高碳酸血症通气过度组中，通过调整呼气末二氧化碳（ETCO2）至 6.0-7.3 kPa 范围，以维持每分钟通气量在 10-15 l/min。采用配对 t 检验和方差分析比较恢复指数。

结果

在拔管前，高碳酸血症通气过度组和对照组的分钟通气量和 ETCO2 分别为 10.3 ± 1.7 l/min 和 5.4 ± 1.2 l/min（P < 0.001），6.6 ± 0.6 kPa 和 5.2 ± 0.5 kPa（P < 0.001）。与对照组相比，研究组拔管时间更短[4.4 ± 1.3（SD）比 9.8 ± 4.4 min，P < 0.01]，BIS 恢复到> 75 的时间更短[2.4 ± 0.9 比 6.1 ± 3.1 min，P < 0.01]，睁眼时间更早[3.9 ± 1.6 比 9.8 ± 6.2 min，P < 0.01]，有资格离开手术室的时间更早[5.1 ± 1.2 比 11.1 ± 4.6 min，P < 0.01]，以及进入麻醉后恢复室（PACU）的时间更早[73.9 ± 14.2 比 89.4 ± 22.6 min，P < 0.01]。