Pharyngeal Function and Airway Protection During Subhypnotic Concentrations of Propofol, Isoflurane, and Sevoflurane

Sundman, Eva; Witt, Hanne; Sandin, R.; Kuylenstierna, Richard; Bodén, Katarina; Ekberg, Olle; Eriksson, Lars

doi:10.1097/00000542-200111000-00016

Cited by 104 publications

(56 citation statements)

References 14 publications

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“…One such study examined airway protection at subhypnotic doses of anesthetics and found that all anesthetics tested compromised pharyngeal function. Furthermore, propofol had the greatest effect upon pharyngeal contraction pattern, 91 a finding that agrees with the animal study. 89 Another clinical trial 92 suggests that ketamine has similar protective effects on ventilatory drive as that observed in preclinical trials.…”

Section: Educationsupporting

confidence: 88%

Postoperative Respiratory Muscle Dysfunction

2013

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Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

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Section: Educationsupporting

confidence: 88%

Postoperative Respiratory Muscle Dysfunction

2013

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“…Propofol in rats is more respiratory depressant than isoflurane given at equianalgesic doses, which seems to be similar in humans, during anesthesia, 44 and during sedation under spontaneous ventilation. 45 If our results obtained in rats translate to the clinical situation of patients scheduled to undergo surgery, then the choice of the anesthetic agent might influence the safety of patients with airways unprotected by an endotracheal tube or a laryngeal mask, during conscious sedation, 43,46 or in extubated patients recovering from general anesthesia. 47 The strong impairing effects of propofol on upper airway dilator muscle function were reversed by carbon dioxide administration, which increased respiratory drive.…”

Section: Possible Clinical Implicationsmentioning

confidence: 96%

“…Some studies in humans suggest that subhypnotic concentrations of propofol have stronger decreasing effects on upper esophageal sphincter resting tone than isoflurane, 43 whereas other data suggest the opposite. 7,8 To our knowledge, it is unclear what the effects of equianesthetic concentrations of propofol and isoflurane on upper airway dilator muscle function might be.…”

Section: Possible Clinical Implicationsmentioning

confidence: 99%

Differential Effects of Isoflurane and Propofol on Upper Airway Dilator Muscle Activity and Breathing

et al. 2008

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Background: Anesthesia impairs upper airway integrity, but recent data suggest that low doses of some anesthetics increase upper airway dilator muscle activity, an apparent paradox. The authors sought to understand which anesthetics increase or decrease upper airway dilator muscle activity and to study the mechanisms mediating the effect.Methods: The authors recorded genioglossus electromyogram, breathing, arterial blood pressure, and expiratory carbon dioxide in 58 spontaneously breathing rats at an estimated ED 50 (median effective dose) of isoflurane or propofol. The authors further evaluated the dose-response relations of isoflurane under different study conditions: (1) normalization of mean arterial pressure, or end-expiratory carbon dioxide; (2) bilateral lesion of the Kölliker-Fuse nucleus; and (3) vagotomy. To evaluate whether the markedly lower inspiratory genioglossus activity during propofol could be recovered by increasing flow rate, a measure of respiratory drive, the authors performed an additional set of experiments during hypoxia or hypercapnia.Results: In vagally intact rats, tonic and phasic genioglossus activity were markedly higher with isoflurane compared with propofol. Both anesthetics abolished the genioglossus negative pressure reflex. Inspiratory flow rate and anesthetic agent predicted independently phasic genioglossus activity. Isoflurane dose-dependently decreased tonic and increased phasic genioglossus activity, and increased flow rate, and its increasing

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“…In the last few years, several anaesthetic protocols combining propofol for its depression of laryngeal reflexes (Sundman et al 2001) with various doses of opioids have attempted to challenge the quality of intubation provided by muscle relaxants. Nevertheless, laryngoscopy and tracheal intubation create very intense but brief noxious stimuli and therefore call for a very deep level of analgesia to be maintained only for a short duration.…”

Section: Induction and Airway Controlmentioning

confidence: 99%

Remifentanil and Other Opioids

Servin

Billard

Handbook of Experimental Pharmacology

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Most opioids used in anaesthesia are of the anilidopiperidine family, including fentanyl, alfentanil, sufentanil and remifentanil. While all share similar pharmacological properties, remifentanil, the newest one, is probably the most original, which is the reason this review focusses especially on this drug. Remifentanil is a potent mu-agonist that retains all the pharmacodynamic characteristics of its class (regarding analgesia, respiratory depression, muscle rigidity, nausea and vomiting, pruritus, etc.) but with a unique pharmacokinetic profile that combines a short onset and the fastest offset, independent of the infusion duration. Consequently, it offers a unique titratability when its effects need to be quickly achieved or suppressed, but it requires specific drug delivery schemes such as continuous infusion, target-controlled infusion and anticipated postoperative pain treatment. Kinetic differences between opioids used in anaesthesia and some clinical uses of remifentanil are reviewed in this chapter.

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Pharyngeal Function and Airway Protection During Subhypnotic Concentrations of Propofol, Isoflurane, and Sevoflurane

Cited by 104 publications

References 14 publications

Postoperative Respiratory Muscle Dysfunction

Postoperative Respiratory Muscle Dysfunction

Differential Effects of Isoflurane and Propofol on Upper Airway Dilator Muscle Activity and Breathing

Remifentanil and Other Opioids

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