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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A796
October 24, 2005 2:00:00 PM - 3:30:00 PM Room C303 |
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| Clinical Evaluation of a Device To Speed Emergence from Sevoflurane Anesthesia | ||||||||||||
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Derek J. Sakata, M.D., Nishant Gopalakrishnan, B.S., Joseph A. Orr, Ph.D., Julia White, R.N., B.S. Anesthesiology, University of Utah, Salt Lake City, Utah, United States |
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Introduction: Ideal conditions for rapid emergence from volatile inhaled anesthesia include hyperventilation to quickly remove volatile agent from the lungs, and slight hypercapnia to elevate blood flow to the brain. We evaluated a rebreathing device that allows simultaneous hyperventilation and hypercapnia during emergence. The device uses an expandable tube placed between the patient and the breathing circuit y-piece to create partial rebreathing. Partial rebreathing allows maintenance of a normal to slightly elevated CO2 during hyperventilation. To prevent rebreathing of anesthetic gas, the device incorporates a small canister of anesthetic absorbent placed between the endotracheal tube and the rebreathing tube. The combination of a rebreathing tube and an anesthetic absorber allows simultaneous hyperventilation and slight hypercapnia during emergence. Methods: After IRB approval, 12 ASA class 1 and 2 patients scheduled to receive elective surgery were recruited for the study. Six patients each were randomly assigned to each group (control and experimental). Anesthesia was maintained using 1 MAC of sevoflurane incombination with the anesthetist's choice of type and amount of opioid, along with a continuous infusion of 0.05-0.3 mcg/kg/min of remifentanil. Emergence was initiated when adhesive wound closure strips were applied. Events were recorded from the time that the sevoflurane vaporizer was turned off. Fresh gas flow was increased to 10 L/min during emergence in both control and experimental groups. Emergence minute ventilation was doubled in the experimental group receiving the test device. Times to eye and mouth opening in response to command and extubation were recorded. Results: The table below shows the average times to emergence events. Experimental group patients received an average of 3.27 MAC-hours and control subjects received an average of 2.13 MAC-hours of sevoflurane. The figure below shows the average times for each of the emergence events for both groups.[table1]Discussion: The differences observed in this data indicate that by using hypercapnic, hyperventilation a considerable decrease in emergence time of 6.95 minutes (54%) was achieved. Similarly, time to extubation was more predictable when using the device as reflected by the 1-minute decrease in the standard deviation of the emergence time. The data also shows that lower blood and tissue solubility are still relevant given that an earlier test with this device when used with isoflurane showed an emergence time decrease of 10 minutes.[figure1] Anesthesiology 2005; 103: A796 |
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Figure 1
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