Hypercapnia does not shorten emergence time from propofol anesthesia: a pilot randomized clinical study

다국어 초록 (Multilingual Abstract)

Background: The elimination of anesthetic agents is a decisive factor in the emergence from general anesthesia. In this pilot study, we hypothesized that hypercapnia would decrease the emergence time from propofol anesthesia by increasing cardiac output and cerebral blood flow.
Methods: A total of 32 patients were randomly divided into two groups based on the end-tidal carbon dioxide values: 30 mmHg (the hypocapnia group) and 50 mmHg (the hypercapnia group). Propofol and remifentanil were infused to maintain a bispectral index of 40–50. Remifentanil infusion was stopped 10 min before the discontinuation of propofol. After cessation of propofol infusion, ventilation settings in the hypocapnia group were maintained constant; a rebreathing tube was connected to the respiratory circuit in the hypercapnia group. The time to spontaneous respiration, eye opening (primary endpoint), mouth opening, and tracheal extubation was recorded and analyzed.
Results: Time to eye opening was 9.7 (1.3) min in the hypocapnia group and 9.0 (1.0) min in the hypercapnia group. The difference in the mean times to eye opening between groups was −0.7 min (95% CI, −4.0 to 2.7, P = 0.688). On multiple regression analysis, there was a significant difference in the mean time to eye opening between males and females. Females recovered about 3.6 min faster than males (95% CI, −6.1 to −1.1, P = 0.009).
Conclusions: We could not detect a beneficial effect of hypercapnia on propofol emergence time. Irrespective of hypercapnia, females seemed to recover faster than males.

참고문헌 (Reference)

1 Gan TJ, "Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men" 90 : 1283-1287, 1999

2 Weber T, "Tromethamine buffer modifies the depressant effect of permissive hypercapnia on myocardial contractility in patients with acute respiratory distress syndrome" 162 : 1361-1365, 2000

3 Apfelbaum JL, "The initial clinical experience of 1819 physicians in maintaining anesthesia with propofol: characteristics associated with prolonged time to awakening" 77 (77): S10-S14, 1993

4 Andrzejowski J, "The effect of intravenous epinephrine on the bispectral index and sedation" 55 : 761-763, 2000

5 Choong E, "Sex difference in formation of propofol metabolites: a replication study" 113 : 126-131, 2013

6 Sakata DJ, "Rapid recovery from sevoflurane and desflurane with hypercapnia and hyperventilation" 105 : 79-82, 2007

7 Takizawa D, "Propofol concentrations during the anhepatic phase of living-related donor liver transplantation" 76 : 648-649, 2004

8 Kurita T, "Influence of cardiac output on plasma propofol concentrations during constant infusion in swine" 96 : 1498-1503, 2002

9 Sakata DJ, "Hypercapnic hyperventilation shortens emergence time from isoflurane anesthesia" 104 : 587-591, 2007

10 Gopalakrishnan NA, "Hypercapnia shortens emergence time from inhaled anesthesia in pigs" 104 : 815-821, 2007

11 Akca O, "Hypercapnia improves tissue oxygenation" 97 : 801-806, 2002

12 Takizawa D, "Human kidneys play an important role in the elimination of propofol" 102 : 327-330, 2005

13 Kuipers JA, "First-pass lung uptake and pulmonary clearance of propofol: assessment with a recirculatory indocyanine green pharmacokinetic model" 91 : 1780-1787, 1999

14 Myburgh JA, "Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model" 27 : 276-282, 2001

15 Sakabe T, "Effects of anesthetic agents and other drugs on cerebral blood flow, metabolism, and intracranial pressure;Cottrell and Young's Neuroanesthesia. 5th ed." Mosby/Elsevier 78-94, 2010

16 Nurcan Kizilcik, "Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial" 대한마취통증의학회 68 (68): 556-560, 2015

17 Cenic A, "Cerebral blood volume and blood flow at varying arterial carbon dioxide tension levels in rabbits during propofol anesthesia" 90 : 1376-1383, 2000

18 Upton RN, "Cardiac output is a determinant of the initial concentrations of propofol after shortinfusion administration" 89 : 545-552, 1999

19 Reekers M, "Basic concepts of recirculatory pharmacokinetic modelling" 523 : 19-26, 2003

20 Walley KR, "Acute respiratory acidosis decreases left ventricular contractility but increases cardiac output in dogs" 67 : 628-635, 1990

21 Sasano H, "A simple apparatus for accelerating recovery from inhaled volatile anesthetics" 93 : 1188-1191, 2001

22 Takizawa D, "A dopamine infusion decreases propofol concentration during epidural blockade under general anesthesia" 52 : 463-466, 2005