Target‐Controlled Infusion in Sleep Endoscopy

Roblin, Graham; Williams, Andrew; Whittet, H. B.

doi:10.1097/00005537-200101000-00031

Cited by 46 publications

(36 citation statements)

References 9 publications

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“…Although the depth of sedation (with spontaneous respiration and the ability to tolerate fiberoptic endoscopy) remained within a defined range, some authors have proposed standardizing propofol dose with use of target-controlled infusion, a proprietary technology (Diprifusor; Astra-Zeneca Inc, London, England) that calculates effect site (brain) concentration using a 3-compartment pharmacokinetic model. 19,20 This approach is well suited to demonstrating the effects of varying propofol doses, but our objective is based on the target depth of anesthesia. Instead, our work and that of others 18 has shown that different subjects will achieve a defined level of sedation at different propofol doses, so we instead targeted the depth of sedation and adjusted propofol infusion rates accordingly.…”

Section: Resultsmentioning

confidence: 99%

Interrater Reliability of Drug-Induced Sleep Endoscopy

Kezirian

White²,

Malhotra³

et al. 2010

Arch Otolaryngol Head Neck Surg

194

201

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Section: Resultsmentioning

confidence: 99%

Interrater Reliability of Drug-Induced Sleep Endoscopy

Kezirian

White²,

Malhotra³

et al. 2010

Arch Otolaryngol Head Neck Surg

194

201

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“…In 2001, Roblin [7] introduced a technique of DISE in which the blood concentration of sedative agent was treated by target-controlled infusion (TCI) 7. TCI system has been developed to provide improved convenience and control during intravenous anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study

Vito

Agnoletti

Berrettini

et al. 2010

Eur Arch Otorhinolaryngol

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Understanding the sites of pharyngeal collapse is mandatory for surgical treatment decision-making in obstructive sleep-apnea-hypopnea syndrome patients. Drug-induced sleep endoscopy (DISE) allows for the direct observation of the upper airway during sedative-induced sleep. In order to re-create snoring and apnea patterns related to a spontaneous sleep situation, the authors used a target-controlled infusion (TCI) sleep endoscopy (DISE-TCI), comparing this technique to conventional DISE, in which sedation was reached by a manual bolus injection. The authors conducted a prospective, randomized, unicenter study. The apneic event observation and its correlation with pharyngeal collapse patterns is the primary endpoint; secondary endpoints are defined as stability and safety of sedation plans of DISE-TCI technique. From January 2009 to June 2009, 40 OSAHS patients were included in the study and randomized allocated in two groups: the bolus injection conventional DISE group and the DISE-TCI group. We recorded the complete apnea event at the oropharynx and hypopharynx levels in 4 patients of the conventional DISE group (20%) and in 17 patients of the DISE-TCI group (85%) (P < 0.0001). Two patients needed oxygen in the conventional DISE group because of severe desaturation that resulted from the first bolus of propofol (1 mg/kg) (P = 0.4872 ns). We recorded the instability of the sedation plan in 13 patients from the conventional DISE group (65%) and 1 patient from the DISE-TCI group (5%) (P = 0.0001). Our results suggest that the DISE-TCI technique should be the first choice in performing sleep endoscopy because of its increased accuracy, stability and safety.

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“…Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level. 5 TCI of propofol uses computer-based pharmacokinetic and pharmacodynamic models to predict and…”

mentioning

confidence: 99%

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

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achieve a target effect site (brain) concentration of propofol. However, patients may lose consciousness at variable effect site concentrations (Ce), with a higher Ce being associated with higher upper airway critical closing pressure.6,7 Most DISE procedures are started shortly after the patients lose consciousness. Objective:To evaluate the effect of sedation depth on druginduced sleep endoscopy (DISE). Methods: Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation). Results: For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confi dence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE fi ndings at different times and different observers (kappa value 0.6 to 1, respectively 1 Drug-induced sleep endoscopy (DISE) has been used for decades to directly examine the upper airways in sedative-induced sleep and improve treatment outcomes by acting as an adjuvant tool to assess surgical or nonsurgical treatment options. 2-4Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.5 TCI of propofol uses computer-based pharmacokinetic and pharmacodynamic models to predict and Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep EndoscopyYu-Lun Lo, MD BRIEF SUMMARYCurrent Knowledge/Study Rationale: Drug-induced sleep endoscopy (DISE) were performed under different sedative conditions and might affect upper airway obstructions. We aimed to evaluate the affects of sedation depth and obstructive sleep apnea severity on different upper airway obstruction patterns. Study Impact: Under DISE, sedation depth affected velopharynx and oropharynx obstruction severity, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse; however, OSA severity was associated with velopharynx and oropharynx obstruction severity as well as arytenoid prolapse. Bispectral index guided DISE offers an objective and reproducible method to evaluate upper airway collapsibility.

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Target‐Controlled Infusion in Sleep Endoscopy

Cited by 46 publications

References 9 publications

Interrater Reliability of Drug-Induced Sleep Endoscopy

Interrater Reliability of Drug-Induced Sleep Endoscopy

Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

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