Universität zu Köln

Simons, Jeroen C. P., Pierce, Eric, Diaz-Gil, Daniel ORCID: 0000-0002-4179-5570, Malviya, Sanjana A., Meyer, Matthew J., Timm, Fanny P., Stokholm, Janne B., Rosow, Carl E., Kacmarek, Robert M. and Eikermann, Matthias (2016). Effects of Depth of Propofol and Sevoflurane Anesthesia on Upper Airway Collapsibility, Respiratory Genioglossus Activation, and Breathing in Healthy Volunteers. Anesthesiology, 125 (3). S. 525 - 535. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1528-1175

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Abstract

Background: Volatile anesthetics and propofol impair upper airway stability and possibly respiratory upper airway dilator muscle activity. The magnitudes of these effects have not been compared at equivalent anesthetic doses. We hypothesized that upper airway closing pressure is less negative and genioglossus activity is lower during deep compared with shallow anesthesia. Methods: In a randomized controlled crossover study of 12 volunteers, anesthesia with propofol or sevoflurane was titrated using a pain stimulus to identify the threshold for suppression of motor response to electrical stimulation. Measurements included bispectral index, genioglossus electromyography, ventilation, hypopharyngeal pressure, upper airway closing pressure, and change in end-expiratory lung volume during mask pressure drops. Results: A total of 393 attempted breaths during occlusion maneuvers were analyzed. Upper airway closing pressure was significantly less negative at deep versus shallow anesthesia (-10.8 +/- 4.5 vs. -11.3 +/- 4.4 cm H2O, respectively [mean +/- SD]) and correlated with the bispectral index (P < 0.001), indicating a more collapsible airway at deep anesthesia. Respiratory genioglossus activity during airway occlusion was significantly lower at deep compared with light anesthesia (26 +/- 21 vs. 35 +/- 24% of maximal genioglossus activation, respectively; P < 0.001) and correlated with bispectral index (P < 0.001). Upper airway closing pressure and genioglossus activity during airway occlusion did not differ between sevoflurane and propofol anesthesia. Conclusions: Propofol and sevoflurane anesthesia increased upper airway collapsibility in a dose-dependent fashion with no difference at equivalent anesthetic concentrations. These effects can in part be explained by a dose-dependent inhibiting effect of anesthetics on respiratory genioglossus activity.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Simons, Jeroen C. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pierce, Eric UNSPECIFIED UNSPECIFIED UNSPECIFIED Diaz-Gil, Daniel UNSPECIFIED orcid.org/0000-0002-4179-5570 UNSPECIFIED Malviya, Sanjana A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Matthew J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Timm, Fanny P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stokholm, Janne B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosow, Carl E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kacmarek, Robert M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eikermann, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-263833
DOI:	10.1097/ALN.0000000000001225
Journal or Publication Title:	Anesthesiology
Volume:	125
Number:	3
Page Range:	S. 525 - 535
Date:	2016
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1528-1175
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OBSTRUCTIVE SLEEP-APNEA; MUSCLE-ACTIVITY; PREDICT IMMOBILITY; PAINFUL STIMULI; NERVE ACTIVITY; HEART-RATE; F-WAVES; PRESSURE; MIDAZOLAM; SEDATION Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26383