Respiratory Volume Monitoring to Assess the Effect of Airway Maneuvers on Ventilation during Upper Endoscopy

Abstract

Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were signif-* Corresponding author. K. Holley et al. 282 icantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.

The relationship between minute ventilation and end tidal CO2 in intubated and spontaneously breathing patients undergoing procedural sedation

“…Furthermore, Holley et al demonstrated the superiority of MV moniting over monitoring RR alone during procedural sedation for upper endoscopic procedures [ 33 ]. During these procedures, the RVM detected decreases in MV in response to sedatives and also identified increases in MV following airway maneuvers such as chin lifts and jaw thrusts [ 34 , 35 ]. In addition to changes in MV, the RVM is also able to detect periods of airway obstruction [ 12 ].…”

Safety and tolerability of esketamine in propofol based sedation for endoscopic variceal ligation with or without injection sclerotherapy: Randomized controlled trial

“…According to the group allocation, the patients in four groups were respectively sedated using propofol 1.5 mg/kg and sufentanil 0.1 μg/kg (group S), propofol 1.5 mg/kg and esketamine 0.2 mg/kg (group E0.2), propofol 1.5 mg/kg and esketamine 0.3 mg/kg (group E0.3), and propofol 1.5 mg/kg and esketamine 0.4 mg/kg (group E0.4). The dosage of propofol and sufentanil was determined according to the Chinese endoscopic guideline 16 and previous studies 17–19 . Esketamine or sulfentanil were prepared according to bodyweight and diluted with normal saline into a 10 mL syringe, then given to the patient 2 min before propofol.…”

“…The dosage of propofol and sufentanil was determined according to the Chinese endoscopic guideline 16 and previous studies. [17][18][19] Esketamine or sulfentanil were prepared according to bodyweight and diluted with normal saline into a 10 mL syringe, then given to the patient 2 min before propofol. Additional propofol 0.5 mg/kg was added to keep patients within target sedation level.…”