Comparison of the effects of sub-hypnotic concentrations of propofol and halothane on the acute ventilatory response to hypoxia

Nagyová, B; Dorrington, Keith L.; Gill, E. W.; Robbins, Peter A.

doi:10.1093/bja/75.6.713

Cited by 31 publications

(10 citation statements)

References 21 publications

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“…TCI allows rapid and precise adjustment of propofol concentration according to the clinical response of the patient. Sedation with propofol in TCI preserves spontaneous ventilation and hemodynamic parameters [21][22][23][24]. We have previously reported the use of TCI with propofol to achieve adequate compliance with NIV [24].…”

Section: Introductionmentioning

confidence: 99%

Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

et al. 2011

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“…If study conditions affect the outcome of experiments, it is unclear why they should influence only the results for isoflurane. A superficial review would suggest that, although such study conditions vary between studies examining halothane [1–8] and enflurane [16–18], the results obtained do not vary. The emphasis on audiovisual stimulation might also be questioned; simply watching television appears to prevent the marked depression by low‐dose anaesthetic [13], yet painful electric shock has no effect [19].…”

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confidence: 99%

The variable effect of low‐dose volatile anaesthetics on the acute ventilatory response to hypoxia in humans: a quantitative review

Pandit

2002

Anaesthesia

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SummaryThe purpose of this study was to review published studies (identified by a Medline-assisted search) on the effect of £ 0.2 minimal alveolar concentration (MAC) halothane, isoflurane, enflurane and sevoflurane on the acute hypoxic ventilatory response in healthy subjects. Each article was examined for the anaesthetic agent, speed of hypoxic stimulus, background carbon dioxide and subject stimulation (audiovisual or painful). Analysis of variance was used to assess the significance of the influence of each of these factors on the standardised hypoxic response (the acute hypoxic ventilatory response in l.min )1 in the presence of anaesthetic, expressed as a fraction of the response without anaesthetic). There were 37 separate studies within 21 published articles. The main factor influencing standardised hypoxic response was anaesthetic agent (p < 0.002). A second influential factor was subject stimulation (p < 0.014), but the interaction term of agent and stimulation was also significant (p < 0.039), suggesting that the influence of stimulation varied with the agent used. Speed of hypoxia and background carbon dioxide had no influence. In contrast to previous authors' assertions that study conditions have a major impact on the acute ventilatory response to hypoxia, this review suggests that the main determinant is simply the anaesthetic agent used. The review also highlights important gaps in the research literature, which may direct future research in this field. In particular, it would seem important to investigate the influence of arousal when different anaesthetic agents are used.Keywords Ventilation: hypoxia, systematic review. [16][17][18], the results obtained do not vary. The emphasis on audiovisual stimulation might also be questioned; simply watching television appears to prevent the marked depression by low-dose anaesthetic [13], yet painful electric shock has no effect [19].An alternative possibility is that variability across anaesthetic agents is simply due to different agents used [21]; but that variability within studies examining a single anaesthetic agent may be due to study conditions. The factors in study conditions which have received most attention are ramp vs. step hypoxia, the level of background carbon dioxide and the presence or absence of subject stimulation [23][24][25]. It would be desirable, though challenging, to conduct a single, large study incorporating all these study factors and employing all the common volatile agents to assess the contribution of each factor to variability. In the absence of such a study, a quantitative systematic review of the published literature is appropriate. It is perhaps interesting that, after more than 30 years of work in this field, no review exists which systematically documents published results on the effect of low dose volatile agents on the acute hypoxic ventilatory response.The purpose of this study was to search, collect and document relevant publications in the field and then explore the data for the main factors influencing the result...

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“…Perhaps of equal importance is the role of episodic or intermittent hypoxia, sustained hypoxia. It is possible that intravenous anaesthetics have a very different effect on AHVR [116]. Because they were commonly used only for induction, with anaesthesia subsequently maintained using volatile agents, the practical consequences of intravenous agent effects on postoperative respiratory control were somewhat limited.…”

Section: Discussionmentioning

confidence: 99%

Volatile Anaesthetic Depression of the Carotid Body Chemoreflex-Mediated Ventilatory Response to Hypoxia: Directions for Future Research

Pandit

2014

Scientifica

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In assessing whether volatile anaesthetics directly depress the carotid body response to hypoxia it is necessary to combine in meta-analysis studies of when it is “functionally isolated” (e.g., recordings are made from its afferent nerve). Key articles were retrieved (full papers in English) and subjected to quantitative analysis to yield an aggregate estimate of effect. Results from articles that did not use such methodology were assessed separately from this quantitative approach, to see what could be learned also from a nonquantitative overview. Just 7 articles met the inclusion criteria for hypoxia and just 6 articles for hypercapnia. Within these articles, the anaesthetic (mean dose 0.75, standard deviation (SD) 0.40 minimum alveolar concentration, MAC) statistically significantly depressed carotid body hypoxic response by 24% (P = 0.041), but a similar dose (mean 0.81 (0.42) MAC) did not affect the hypercapnic response. The articles not included in the quantitative analysis (31 articles), assessed qualitatively, also indicated that anaesthetics depress carotid body function. This conclusion helps direct future research on the anaesthetic effects on putative cellular/molecular processes that underlie the transduction of hypoxia in the carotid body.

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Comparison of the effects of sub-hypnotic concentrations of propofol and halothane on the acute ventilatory response to hypoxia

Cited by 31 publications

References 21 publications

Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

The variable effect of low‐dose volatile anaesthetics on the acute ventilatory response to hypoxia in humans: a quantitative review

Volatile Anaesthetic Depression of the Carotid Body Chemoreflex-Mediated Ventilatory Response to Hypoxia: Directions for Future Research

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