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                     <i>Upper Airway Reflexes during a Combination of Propofol and Fentanyl Anesthesia</i> </b>

Tagaito, Yugo; Isono, Shiroh; Nishino, Takashi

doi:10.1097/00000542-199806000-00007

Cited by 158 publications

(90 citation statements)

References 13 publications

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“…Third, no control group was included in this study; however, the stability of the model over a specific time frame has been previously examined in a separate group of children anaesthetised with sevoflurane and exposed to three repeated laryngeal stimulations [19] in a similar manner to those in the present study. The laryngeal and respiratory reflex responses were remarkably constant in successive stimulations and the results were in agreement with the work of Tagaito et al [11], who found no significant differences in the incidence of laryngeal and respiratory reflex responses that could be accredited to repeat stimulation. Given these circumstances, it was felt unnecessary to include a control group.…”

Section: Discussionsupporting

confidence: 92%

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The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

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Section: Discussionsupporting

confidence: 92%

“…A clinical model using laryngeal stimulation originally developed in adults [11] and adapted to the paediatric setting was applied as we have done in previous studies [10,14]. This model permits detailed analysis of reflex responses under consistent and safe examination conditions.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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“…Laryngeal and pharyngeal refl exes are depressed by propofol. These effects are further potentiated by opioids [5,6]. Thus provocation of refl exes due to mechanical stimulation by laryngoscopy are reduced or abolished by combination of propofol and opioids, thus facilitating the procedure.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for direct laryngoscopy with propofol and fentanyl or sufentanil

Srivastava

Mishra

Sharma

et al. 2008

Indian J Otolaryngol Head Neck S

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Aim & objective To fi nd if direct laryngoscopy (DL) could be done without using succinylcholine and secondly, to acertain the appropriate anesthetic regimen. Patients and methodsIn a double blind placebo controlled study 67 patients aged 40-75 years of age, of both sex requiring direct laryngoscopy (DL) either for diagnosis or for biopsy were enrolled. The patients were randomly divided in three groups. The patients in group F and S received Fentanyl or Sufentanil respectively along with Propofol, whereas those in group N received normal saline (placebo) and propofol. The conditions of laryngoscopy, hemodynamic parameters and any adverse events were recorded. Good or fair conditions for laryngoscopy were achieved in 91% (21), 87% (19) and 73% (16) of patients in groups F, S and N respectively (p < 0.05) in favor of group F and S. During DL arterial pressure and pulse rate changes were minimal when propofol was administered along with opioids, (group F and S) compared to group N where only propofol was used.Results No serious side effects were seen in the three groups. Hence by these fi ndings we concluded that better conditions of DL are achieved during anesthesia with propofol and fentanyl and sufentanil alone. The opioids provided additional benefi t of stable hemodynamics.

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“…Moreover, after 3 h and 6 h the AG performance was still slower, though not less accurate, than the CG performance. Propofol, fentanyl, and midazolam suppress the laryngeal and pharyngeal responses, which are crucial to vocalisation [19][20][21]. However, the pharmacokinetic properties of a hypnotic agent seem to exclude such a possibility -propofol disappears from the effectory compartment after several minutes and its metabolites are inactive.…”

Section: Discussionmentioning

confidence: 99%

Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning?

Płotek¹,

Cybulski²,

Łockiewicz³

et al. 2014

Anaesthesiol Intensive Ther

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Background: The aim of this study was to examine the phonological functioning (reading speed and accuracy) of hospital patients under general anaesthesia administered during colonoscopy. Methods: In this study the 'Łatysz' non-word reading test was used to measure the impact of selected anaesthetics on the phonological aspect of language processing (defined as decoding without referring to the meaning) in a group of 22 anaesthetised patients compared to 23 non-anaesthetised patients from university clinics. Results: Compared to the preoperative performance, a decrease in reading accuracy and reading speed was observed only in the Anaesthesia Group -AG (in the subjects aged ≥ 35 years) 1.5 h after the administration of anaesthetics. Postoperatively, the AG were significantly slower and less accurate than the Control Group -CG -after 1.5 h. After 3 h, the AG had regained their baseline values both in reading accuracy and reading speed. During the last assessment session, the AG pronounced 82% of the words correctly, while the CG pronounced 74% correctly. Moreover, subjects aged ≥ 35 years performed worse than younger subjects in their reading accuracy and speed. Conclusions: The patients who underwent colonoscopy under general anaesthesia manifested impaired phonological functioning shortly after the procedure, both in the speed and accuracy of reading non-words. However, the accuracy problems subsided relatively quickly.

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Upper Airway Reflexes during a Combination of Propofol and Fentanyl Anesthesia

Abstract: Incremental doses of fentanyl depress airway reflex responses in a dose-related manner, except for apnea with laryngospasm.

Cited by 158 publications

References 13 publications

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Anaesthesia for direct laryngoscopy with propofol and fentanyl or sufentanil

Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning?

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