Effects of Capnometry Monitoring in Post Anesthesia Care Unit

Study Overview
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Brief Summary
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There is few information about the best capnometry value in recovery room for intubated awakening patients. Furthermore, capnometry values could influence ventilation applied by nurses on these patients. The aim of this study is to observe the effects of capnometry monitoring on intubated awakening patients in recovery room.

Detailed Description
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In France, there is actually no recommandation about capnography monitoring in recovery rooms. Nevertheless, some patients are still ventilated in post-anesthesia care units during awakening period. Alveolar hypoventilation could induce moderate hypercapnia, thereby stimulate central ventilatory command. However, this hypoventilation could delay the clearance of anesthetic gases. Capnometry monitoring could influence ventilation applied to these patients. Recovery rooms nurses would perform moderate hyperventilation in response to hign capnometry values. This method could enhance gases elimination, with faster spontaneous breathing recovery and extubation. Length of stay in recovery room could also be shortened. An objective surrogate of ventilation is maximal End Tidal CO2, if there is no alveolo-capillary gradient abnormality (Obesity, Chronic respiratory disease, Cyanogenic heart disease). Thus, this study will compare the percentage of patients who reached a maximum End Tidal CO2 greater than 45mmHg during awakening period in post-anesthesia care unit (PACU) in 2 groups : first group (non-blind group) with capnography monitoring see by the PACU nurses second group (blind group) with capnography monitoring but PACU nurses cannot see the values Other parameters like the time between ventilator's disconnection and the first ventilatory cycle in spontaneous ventilation, the time between ventilator's disconnection and tracheal extubation or laryngeal mask's withdrawal, the minimal SpO2 reached after tracheal extubation or laryngeal mask withdrawal or the length of stay in PACU are also recorded.

Official Title
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Effects of Capnometry Monitoring in Post Anesthesia Care Unit

Conditions
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VENTILATION, Capnography

Intervention / Treatment
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* Device: CAPNOGRAPHY


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Major patients with given written consent General anesthesia, induction with Propofol infusion and Target-Controlled Infusion (TCI) remifentanil, relayed with inhaled sevoflurane and TCI remifentanil Upper airway control with naso-orotracheal tube or laryngeal mask Ventilated normotherm patients in PACU Exclusion Criteria: Minor or pregnant patients Obesity with Body Mass Index > 40 kg/m² Chronic respiratory disease with SpO2<90% in ambiant air Cyanogenic heart disease Patients under myorelaxant in PACU

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CAPNO+<br>END TIDAL CO2(EtCO2) is monitoring and PACU nurses can see the values delivered by the capnography device | Device: CAPNOGRAPHY<br>* MONITORING OF CAPNOMETRY USING ETCO2 METHOD<br>|
| No Intervention: CAPNO-<br>END TIDAL CO2(EtCO2) is monitoring but PACU nurses cannot see the values delivered by the capnography device | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| End Tidal CO2 up | Percentage of patients who reached a maximum End Tidal CO2 greater than 45mmHg during awakening period in post-anesthesia care unit (PACU) | through awakening period in PACU, an average of 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| End Tidal CO2 max 1 | Maximum EtCO2 reached before the first ventilatory cycle in spontaneaous ventilation | through awakening period in PACU, an average of 15 minutes | 
| End Tidal CO2 max 2 | Maximum EtCO2 reached after the first ventilatory cycle in spontaneous ventilation | through awakening period in PACU, an average of 30 minutes | 
| respiratory rate | Respiratory rate applied by PACU nurse before the first ventilatory cycle in spontaneous ventilation | through awakening period in PACU, an average of 15 minutes | 
| spontaneous ventilation time | Time (in minutes) between ventilator's disconnection and the first ventilatory cycle in spontaneous ventilation | through awakening period in PACU, an average of 15 minutes | 
| time for removal of airway device | Time (in minutes) between ventilator's disconnection and tracheal extubation or laryngeal mask's withdrawal | through awakening period in PACU, an average of 30 minutes | 
| Spo2 min | Minimal SpO2 after tracheal extubation or laryngeal mask withdrawal | through awakening period in PACU, an average of 2 hours | 
| length of stay in PACU | Length of stay in PACU in minutes | through awakening period in PACU, an average of 2 hours | 
| time for oxygenotherapy removal | Time (in minutes) between tracheal extubation or laryngeal mask withdrawal and oxygenotherapy weaning | through awakening period in PACU, an average of 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Capnometry, Capnography, ETCO2, Recovery room, Post-anesthesia care unit