Oxygen drive to breathing during halothane anesthesia: effects of almitrine bismesilate

The changes in ventilation and breathing pattern induced by the substitution of pure oxygen for room air were tested in patients during stable halothane anesthesia before and after the administration of almitrine bismesilate, a specific stimulant of the peripheral chemoreceptors. Ventilation was monitored in 25 patients for 15 min while breathing an air-halothane (1.5%) mixture and while breathing then for 10 min an O2-halothane (1.5%) mixture. The maneuver was repeated in 11 of these patients after the infusion of 0.5 mg/kg of almitrine bismesilate. Before almitrine administration, O2 inhalation caused a progressive decrease of minute-ventilation (VE) reaching 94.5 +/- 1.4% (mean +/- SEM) of the initial value at the tenth minute (P less than 0.01). This decrease was secondary to a progressive increase of inspiratory and expiratory times. Almitrine bismesilate caused a significant increase in VE (+11.6%), tidal volume (+14.0%), and mean inspiratory flow (+10.0%) when breathing the air-halothane mixture. Ten minutes after O2 administration, these variables were not different from those observed before almitrine infusion. This study shows that during halothane anesthesia, hypoxic ventilatory drive is not abolished but is depressed severely. Almitrine bismesilate can restore the hypoxic ventilatory drive.