The effect of isocapnic hyperventilation on early recovery after remifentanil/sevoflurane anesthesia in O2/air: A randomized trial

Andy De Baerdemaeker, Jan Poelaert, R. Ross Kennedy, Andre M. De Wolf, Jan F.A. Hendrickx*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Isocapnic hyperventilation (ICHV) may hasten emergence from general anesthesia but remains inadequately studied. We prospectively determined emergence time after sevoflurane anesthesia of variable duration with and without ICHV. Methods: In 25 ASA I-II patients, general anesthesia was maintained with one age-adjusted MAC sevoflurane in O2/air and target-controlled remifentanil delivery. At the start of skin closure, the remifentanil effect-site concentration was reduced to 1.5 ng/mL, any residual neuromuscular block reversed, and once the remifentanil effect-site concentration had decreased to 1.5 ng/mL, remifentanil and sevoflurane administration was stopped, and the fresh gas flow increased above minute ventilation. Patients randomly received either normoventilation (n = 13) or ICHV (doubling minute ventilation while titrating CO2 into the inspiratory limb to maintain isocapnia [n = 12]). Three early recovery end points were determined: time to proper response to verbal command; time to extubation; and time to stating one’s name. Results: Demographics were the same in both groups. Recovery end points were reached faster in the ICHV group compared to the normoventilation group: time to proper response to verbal command was 7.6 ± 2.2 vs 9.9 ± 2.9 min (P = 0.03); time to extubation was 7.6 ± 2.6 vs 11.0 ± 2.4 min (P = 0.002); and time to stating one’s name was 8.9 ± 2.8 vs 12.5 ± 2.6 min (P = 0.003). Within each group, duration of anesthesia only marginally affected the times to reach these recovery end points. Conclusion: Isocapnic hyperventilation only had a small effect on emergence times after anesthesia, suggesting that isocapnic hyperventilation may have limited clinical benefits with modern potent inhaled anesthetics.

Original languageEnglish (US)
Pages (from-to)455-460
Number of pages6
JournalActa Anaesthesiologica Scandinavica
Issue number4
StatePublished - Apr 2019

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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