Abstract:
BACKGROUND:Drug-induced sleep endoscopy (DISE) uses sedative-hypnotics to induce moderate obstruction in sleep apnea patients, thereby facilitating anatomic assessment of obstructive physiology. Implementation of DISE with propofol requires a dosing strategy that reliably and efficiently produces obstruction while minimizing oxygen desaturation. METHODS:The surgeon in a prospective study of transoral robotic resection of the tongue base enrolled 97 patients with obstructive sleep apnea confirmed by polysomnography who failed continuous positive airway pressure. All patients were screened by DISE. Propofol dose was determined using custom software written in MATLAB, which has been previously described. Studies were performed in an operating room with standard monitors and resuscitation equipment. No topical anesthesia was used, and no IV drugs other than propofol were used. All patients received 2 L/min supplemental oxygen via a nasal cannula placed in the mouth. After initiation of propofol sedation, a pediatric bronchoscope was positioned via the naris to observe the velopharynx. The sedation sequence was continued until the clinical end point of obstruction onset was noted. Observation of the pharynx was performed for a sufficient period to obtain images of the anatomic site(s) of obstruction. The infusion was then terminated. Statistical analysis was performed with MATLAB (MathWorks, version 2012b). Comparison of saturation nadirs between DISE and subject sleep studies was performed with both the paired and unpaired Student t test. RESULTS:The subject population was characterized by a median body mass index of 32.1 (interquartile range [IQR] 6.8) kg/m and apnea-hypopnea index of 48 (IQR 32). All patients demonstrated obstruction within the design variables. Obstruction was observed after 236 (±57.9) seconds at an estimated effect-site concentration of 4.2 ± 1.3 mcg/mL. The median saturation nadir during DISE was significantly higher (91.4% (IQR 5.1)) than that during standard sleep studies (81.0% [IQR 11.2], P < 0.0001). Ninety-five percent confidence intervals for correlations between DISE saturation nadir and body mass index, age, apnea-hypopnea index, or administered propofol dose included zero in all cases. CONCLUSIONS:A propofol infusion strategy that requires limited experience with propofol dose selection and only 1 pump dosing change reliably produced airway obstruction in patients with severe sleep apnea. Clinical obstruction was achieved faster than target-controlled infusion-based systems for similar procedures reported in the literature. The observed degree of oxygen desaturation in the model system was within a clinically acceptable range.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Atkins JH,Mandel JE,Rosanova Gdoi
10.1213/ANE.0000000000000229subject
Has Abstractpub_date
2014-10-01 00:00:00pages
805-10issue
4eissn
0003-2999issn
1526-7598journal_volume
119pub_type
杂志文章abstract::Effects of halothane, enflurane, and nitrous oxide on ciliary beats were evaluated using a photoelectric system in dissected rabbit tracheal segments. Dose-dependent suppression of the frequency of ciliary beats of moderate degrees was observed after exposure of tracheal segments to warmed and humidified vapors of hal...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1980-06-01 00:00:00
abstract:BACKGROUND:Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard f...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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abstract:BACKGROUND:Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly de...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003574
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200003000-00015
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abstract::The epidural administration of morphine and fentanyl delay the regression of sensory anesthesia in postoperative patients receiving epidural bupivacaine. This study was performed to determine any differential effects of two lipid-soluble opioids upon regression of sensory anesthesia during coadministration with epidur...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199312000-00017
更新日期:1993-12-01 00:00:00
abstract:UNLABELLED:Obese surgical patients are typically considered to be more likely than lean patients to possess high-volume and low-pH (HVLP) gastric contents after a standard preoperative fast, based on a study of a population predominately consisting of patients receiving intramuscular preoperative sedation. We revisited...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199801000-00030
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Near-infrared spectroscopy is used during cardiac surgery to monitor the adequacy of cerebral perfusion. In this systematic review, we evaluated available data for adult patients to determine (1) whether decrements in cerebral oximetry during cardiac surgery are associated with stroke, postoperative cognitiv...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e318277a255
更新日期:2013-03-01 00:00:00
abstract::Spine surgery is associated with a wide range of surgical and anesthetic complications. Excessive cerebrospinal fluid leak can be a cause of cerebellar hemorrhage postoperatively. We report a 43-yr-old patient who had lumbar spine reexploration surgery complicated by a cerebrospinal fluid leak which led to cerebellar ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000143340.51813.6A
更新日期:2005-02-01 00:00:00
abstract:UNLABELLED:Intravenous and volatile general anesthetics inhibit norepinephrine (NE) release from sympathetic neurons and other neurosecretory cells. However, the actions of general anesthetics on NE release from central nervous system (CNS) neurons are unclear. We investigated the effects of representative IV and volat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200211000-00032
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journal_title:Anesthesia and analgesia
pub_type: 指南,杂志文章,评审
doi:10.1213/ANE.0000000000000171
更新日期:2014-05-01 00:00:00
abstract::Recent determinations of the minimum alveolar anesthetic concentration (MAC) for nitrous oxide in rats yield values of 1.51-1.55 atm. When combined with results from other reports, these results suggest a deviation from linear additivity, and call into question the unitary theory of narcosis. The present report provid...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199410000-00016
更新日期:1994-10-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000184119.85400.0E
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Microdialysis studies have demonstrated that the release of serotonin (5-hydroxytryptamine, 5-HT) in the serotonergic projection areas increases during waking and decreases during sleep in rat and cat, suggesting that 5-HT plays an important role in modulation of sleep. Although it might be expected that 5-H...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000255200.42574.22
更新日期:2007-04-01 00:00:00
abstract::The efficacy of lidocaine during myocardial reperfusion in coronary artery bypass surgery was evaluated in 20 patients randomly assigned to a control group (n = 10) or to receive lidocaine, 1 mg/kg intravenously 5 min before aortic unclamping and cardiac reperfusion, followed by infusion at 40 micrograms X kg-1 X min-...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-04-01 00:00:00
abstract::After it was learned that electroanesthesia (EA) could not be produced in a Rhesus monkey which had undergone a circumferential scalp block with 0.25% lidocaine, it was postulated that EA could be produced by electrostimulation of the sensory nerves of the scalp in the rhesus. The work reported here verifies that EA c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197607000-00018
更新日期:1976-07-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000180837.78169.04
更新日期:2005-11-01 00:00:00
abstract::The hemodynamic effects of an induction dose of propofol, 2.5 mg/kg, or etomidate, 0.3 mg/kg, were studied in eight dogs. In addition, cardiodynamic changes were measured using a left ventricular catheter and needle force probes. Propofol was associated with significant decreases in systolic (19.9%) and diastolic (25....
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-07-01 00:00:00
abstract::The cardiovascular responses of aortic cross-clamping and declamping with normal and high ventricular filling pressures were compared during epidural and nitrous oxide-morphine anesthesia in 32 male patients undergoing reconstructive aortic surgery. The patients were divided into four groups. Groups I and II had lumba...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197909000-00005
更新日期:1979-09-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000182
更新日期:2014-05-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199702000-00033
更新日期:1997-02-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200212000-00020
更新日期:2002-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199009000-00012
更新日期:1990-09-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200010000-00049
更新日期:2000-10-01 00:00:00
abstract:UNLABELLED:The last decade has witnessed a proliferation of devices or methods that facilitate intubation in difficult circumstances, maintain ventilation, or which do both. These all require properly functioning and specially designed apparatus, the use of which requires variable degrees of expertise. This technical c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200202000-00045
更新日期:2002-02-01 00:00:00
abstract:UNLABELLED:We determined whether two different devices for measuring near-infrared spectroscopy (NIRS)---the INVOS 4100 and the NIRO 300---produce similar cerebral oxygenation data during the CO(2) challenge test. Nineteen patients anesthetized with sevoflurane, 67% nitrous oxide in oxygen, and fentanyl were studied. A...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200203000-00020
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000004292
更新日期:2020-03-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31827ab89c
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:In vivo animal assays are a cornerstone of preclinical pain research. An optimal stimulus for determining the activity of potential analgesics would produce responses of a consistent magnitude on repeated testing. Intraplantar (i.pl.) injection of hypertonic saline (HS) in mice produces robust nociceptive re...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003593
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Neurotropin, a nonprotein extract isolated from inflamed skin of rabbits inoculated with vaccinia virus, is widely used in Japan to treat chronic pain such as neuropathic pain. Although some studies have been conducted on the mechanism of the antiallodynic action of Neurotropin, this mechanism has yet to be ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31817e7a59
更新日期:2008-09-01 00:00:00