Chemical regulation of ventilation during isoflurane sedation and anaesthesia in humans

Knill, R. L.; Kieraszewicz, H.; Dodgson, Bruce G.; Clement, J. L.

doi:10.1007/bf03015231

Cited by 70 publications

(37 citation statements)

References 18 publications

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“…These findings are in agreement with those of Knill et al (1983). On the other hand, AV stimulation that prevented eye closure or 'sleep' left the hypoxic response intact, as observed by Temp et al (1992).…”

supporting

confidence: 90%

“…The apnoeic threshold decreased from 3-49 + 0 45 to 2-22 + 1-76 kPa (P < 0'0001). The Knill et al (1983) were in a darkened room without audio-visual (AV) stimulation, while those of Temp et al (1992) were required to watch a video documentary. In this study we investigated the effects of 0-1 and 0-2 MAC isoflurane on the ventilatory response to a step decrease in end-tidal PO.…”

mentioning

confidence: 99%

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Respiration & Exercise

1994

The Journal of Physiology

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Skeletal muscle (SM) abnormalities, which may play a role in dyspnoea and fatigue in cardiomyopathic heart failure, could be involved in causing similar symptoms in mitral stenosis. We studied the effects of percutaneous balloon mitral valvuloplasty (BMV) on SM structure and function in eight patients; before BMV as baseline, 2 weeks after BMV for effects of improved haemodynamics and 4 months after BMV for effects of resumption of normal physical activity. Patients underwent (i) exercise (25 W/ 3 min stages) to exhaustion to determine Vos,max, (ii) CT scan for right quadriceps cross-sectional area, (iii) isokinetic testing of peak quadriceps torque (60 deg s-') and fatigue (% force decrease after min of repetitive contraction/ relaxation cycles at 180 deg s') and (iv) quadriceps biopsy for histological (fibre type) and citrate synthase analysis. BMV caused an increase in mitral valve area (0i86 + 0 07 to 182 + 013 cm2 (mean +S.E.M.), P< 0-01), which remained elevated at 4 months (1P76 + 0413 cm2, P < 0-01), and an increase in cardiac output (3-8 + 0418 to 4-6 + 04191 mint, P< 0 05).

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confidence: 90%

mentioning

confidence: 99%

Respiration & Exercise

1994

The Journal of Physiology

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“…Similarly, a subanesthetic dose of isoflurane has been shown to reduce the hypoxemic ventilatory response via peripheral chemoreceptors. 27,28 Patients undergoing surgery frequently receive opioids for the pain control. Opioids have been shown to impair ventilatory function by affecting both peripheral and central carbon dioxide chemoreflex loops .29,30 Studies have shown that small doses of narcotics administered epidurally may also depress the respiratory function, even in healthy adults.…”

Section: Impact Of Sedation Anesthesia and Opioidsmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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“…The observations of Knill et al in the 1970s (since confirmed by many other studies) established that in humans, volatile anaesthetics significantly depress the AHVR [16][17][18]. At low dose (< 0.2 minimum alveolar concentration(MAC)) the degree of depression is …”

Section: Volatile Anaesthetics and Ventilatory Controlmentioning

confidence: 89%

Hypoxia: developments in basic science, physiology and clinical studies

2011

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SummaryAirway management is primarily designed to avoid hypoxia, yet hypoxia remains the main ultimate cause of anaesthetic‐related death and morbidity. Understanding some of the physiology of hypoxia is therefore essential as part of a ‘holistic’ approach to airway management. Furthermore, it is strategically important that national specialist societies dedicated to airway management do not only focus upon the technical aspects of airway management, but also embrace some of the relevant scientific questions. There has been a great deal of research into causation of hypoxia and the body’s natural protective mechanisms and responses to it. This enables us to think of ways in which we might manipulate the cellular and molecular responses to confer greater protection against hypoxia‐induced tissue injury. This article reviews some of those aspects.

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Chemical regulation of ventilation during isoflurane sedation and anaesthesia in humans

Cited by 70 publications

References 18 publications

Respiration & Exercise

Respiration & Exercise

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Hypoxia: developments in basic science, physiology and clinical studies

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