Hypercapnic Hyperventilation to Accelerate Emergence from Inhaled Volatile Anesthetics: A Practical Method Using Standard Hospital Equipment.

Hypercapnic hyperventilation is a technique used to support emergence from volatile anesthesia by allowing a controlled elevation of arterial carbon dioxide (CO₂) levels. The resulting hypercapnia increases minute ventilation, enhances the washout of anesthetic gases from the lungs, and increases cerebral blood flow, which may facilitate faster elimination of volatile agents from brain tissue. Commercial devices have been developed to achieve this effect; however, their availability is limited in many regions. This protocol describes a practical alternative approach using standard anesthesia equipment commonly available in European hospitals. By temporarily removing the CO₂ absorber and reducing fresh gas flow, controlled CO₂ rebreathing is facilitated, while an active charcoal filter eliminates residual volatile anesthetics from the circuit. The protocol provides step-by-step guidance to help achieve the desired end-tidal CO₂ levels safely and efficiently. This method offers a practical and low-cost way to induce hypercapnic hyperventilation, which may be associated with faster emergence from anesthesia under appropriate clinical conditions.