Effects of Depth of Propofol and Sevoflurane Anesthesia on Upper Airway Collapsibility, Respiratory Genioglossus Activation, and Breathing in Healthy Volunteers

Simons, Jeroen Cedric Peter; Pierce, Eric T.; Diaz-Gil, Daniel; Malviya, Sanjana A.; Meyer, Matthew J.; Timm, Fanny P.; Stokholm, J; Rosow, Carl E.; Kacmarek, Robert M.; Eikermann, Matthias

doi:10.1097/aln.0000000000001225

Cited by 25 publications

(18 citation statements)

References 33 publications

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“…U pper airway obstruction and respiratory depression are common side effects of many sedative and anesthetic agents and may put ventilation and oxygenation at risk. [1][2][3][4] A drug that can offer sedation without impairing airway patency and increasing risk of hypoxemia would be ideal in situations where preservation of spontaneous ventilation is desired, such as during sedation in nonintubated patients in intensive care or during diagnostic procedures editor'S PerSPective…”

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confidence: 99%

Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Dexmedetomidine is a sedative promoted as having minimal impact on ventilatory drive or upper airway muscle activity. However, a trial recently demonstrated impaired ventilatory drive and induction of apneas in sedated volunteers. The present study measured upper airway collapsibility during dexmedetomidine sedation and related it to propofol. Methods Twelve volunteers (seven female) entered this nonblinded, randomized crossover study. Upper airway collapsibility (pharyngeal critical pressure) was measured during low and moderate infusion rates of propofol or dexmedetomidine. A bolus dose was followed by low (0.5 μg · kg−1 · h−1 or 42 μg · kg−1 · min−1) and moderate (1.5 μg · kg−1 · h−1 or 83 μg · kg−1 · min−1) rates of infusion of dexmedetomidine and propofol, respectively. Results Complete data sets were obtained from nine volunteers (median age [range], 46 [23 to 66] yr; body mass index, 25.4 [20.3 to 32.4] kg/m2). The Bispectral Index score at time of pharyngeal critical pressure measurements was 74 ± 10 and 65 ± 13 (mean difference, 9; 95% CI, 3 to 16; P = 0.011) during low infusion rates versus 57 ± 16 and 39 ± 12 (mean difference, 18; 95% CI, 8 to 28; P = 0.003) during moderate infusion rates of dexmedetomidine and propofol, respectively. A difference in pharyngeal critical pressure during sedation with dexmedetomidine or propofol could not be shown at either the low or moderate infusion rate. Median (interquartile range) pharyngeal critical pressure was −2.0 (less than −15 to 2.3) and 0.9 (less than −15 to 1.5) cm H2O (mean difference, 0.9; 95% CI, −4.7 to 3.1) during low infusion rates (P = 0. 595) versus −0.3 (−9.2 to 1.4) and −0.6 (−7.7 to 1.3) cm H2O (mean difference, 0.0; 95% CI, −2.1 to 2.1; P = 0.980) during moderate infusion of dexmedetomidine and propofol, respectively. A strong linear relationship between pharyngeal critical pressure during dexmedetomidine and propofol sedation was evident at low (r = 0.82; P = 0.007) and moderate (r = 0.90; P < 0.001) infusion rates. Conclusions These observations suggest that dexmedetomidine sedation does not inherently protect against upper airway obstruction.

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confidence: 99%

Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers

et al. 2019

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“…The effect of halothane was even more dramatic in kittens as the inspiratory activity of their genioglossus muscles was completely abolished when breathing 1.5% halothane . This depressed inspiratory activity of the upper airway muscles has been confirmed for all anesthetics agents except ketamine: for sevoflurane, propofol, and dexmedetomidine in healthy children undergoing magnetic resonance imaging as well as with propofol and dexmedetomidine in healthy adult volunteers …”

Section: Preparing Extubationmentioning

confidence: 73%

Tracheal extubation in children: Planning, technique, and complications

Veyckemans

2020

Pediatric Anesthesia

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Although poorly described in textbooks and rarely a topic of lecture, tracheal extubation is a critical phase of anesthetic care. It should therefore be carefully planned taking into account simple physiology‐based principles to maintain the upper airway patent and avoid lung de‐recruitment, but also the pharmacology of all anesthetic agents used. Although the management of most of its complications can be learned in a clinical simulation environment, the basic techniques can so far only be taught at the bedside, in the operating room. In this paper, the process of extubation is described in successive steps: preparation, return to adequate spontaneous ventilation, awake versus deep extubation, timing according to the child's breathing cycle, extubation in the operating room or in the Postanesthesia Care unit, child's management immediately after extubation, diagnosis and treatment of the early complications, and finally, how to prepare for a difficult reintubation.

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“…Manipulasi digital intraoral ini diperlukan pada teknik insersi klasik karena efek obat anestesi menyebabkan perubahan dimensi antero-posterior faring akibat hilangnya tonus otot rangka sehingga menyebabkan obstruksi parsial hingga total pada jalan napas. 17 Penelitian Khrisna, Kamath, Shenoy (2011) menyatakan bahwa LMA dapat dipasang tanpa ikut menginsersi jari telunjuk ke dalam rongga mulut pasien dan dengan teknik TAM memberikan hasil yang lebih baik dibandingkan dengan teknik insersi klasik karena teknik TAM membuka patensi jalan napas dan menurunkan risiko terlipatnya epiglotis. 18 Teknik laringoskopi insersi LMA merupakan teknik insersi dengan menggunakan laringoskop untuk membuka rongga faring, dan mengangkat epiglotis kemudian LMA dimasukkan ke dalam rongga hipofaring pada area supraglotik.…”

Section: Pendahuluanunclassified

Perbandingan Teknik Insersi Triple Airway Maneuver dengan Teknik Laringoskopi Terhadap Keberhasilan Insersi dan Profil Hemodinamik Pemasangan Laryngeal Mask Airway (LMA) Klasik pada Operasi Elektif

Purba

Mafiana

Puspita

2019

JAI b

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Latar Belakang: Manajemen jalan napas merupakan aspek penting dalam anestesiologi. Alat bantu napas yang sering digunakan adalah laringeal mask airway (LMA). Beberapa penelitian telah dilakukan untuk mencari teknik yang dapat meningkatkan angka keberhasilan insersi LMA dan mengurangi komplikasi. Teknik insersi LMA triple airway maneuver (TAM) dan teknik laringoskopi merupakan teknik insersi yang sering dipakai dalam paktik sehari-hari namun keunggulan kedua tehnik ini perlu diketahui lebih lanjut.Tujuan: Mengetahui perbandingan keberhasilan dan profil hemodinamik insersi LMA klasik antara teknik TAM dengan teknik laringoskopi.Metode: Randomized post test only and comparison group design dilakukan di kamar bedah RSUP Dr. Mohammad Hoesin Palembang pada bulan April 2019-Mei 2019 sampai jumlah sampel terpenuhi. Didapatkan total 62 sampel yang memenuhi kriteria inklusi dibagi menjadi dua kelompok, yaitu kelompok teknik TAM dan teknik laringoskopi. Hasil penelitian dianalisis menggunakan uji t-tidak berpasangan dan Chi-square test (p<0,05) dengan SPSS® versi 25.00.Hasil: Keberhasilan pemasangan LMA klasik dengan menggunakan teknik laringoskopi pada usaha pertama dan kecepatan insersi dengan teknik laringoskopi lebih baik daripada teknik TAM (p<0,05). Profil hemodinamik rerata tekanan sistolik pada teknik laringoskopi lebih rendah daripada teknik TAM (p<0,05), namun rerata tekanan diastolik, MAP, dan detak jantung tidak ada perbedaan bermakna (p>0,05). Selain itu ditemukan keluhan sakit tenggorokan (22,6%) dan bercak darah pada LMA pasca ekstubasi (16,1%) pada teknik TAM.Kesimpulan: Keberhasilan dan tekanan darah sistolik pada teknik laringoskopi lebih baik daripada teknik TAM.

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Effects of Depth of Propofol and Sevoflurane Anesthesia on Upper Airway Collapsibility, Respiratory Genioglossus Activation, and Breathing in Healthy Volunteers

Cited by 25 publications

References 33 publications

Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers

Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers

Tracheal extubation in children: Planning, technique, and complications

Perbandingan Teknik Insersi Triple Airway Maneuver dengan Teknik Laringoskopi Terhadap Keberhasilan Insersi dan Profil Hemodinamik Pemasangan Laryngeal Mask Airway (LMA) Klasik pada Operasi Elektif

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