Effects of Subanesthetic Halothane on the Ventilatory Responses to Hypercapnia and Acute Hypoxia in Healthy Volunteers

Dahan, Albert; Elsen, M. J. L. J. van den; Berkenbosch, A.; DeGoede, J.; Olievier, I. C. W.; Kleef, Jack W. van; Bovill, J. G.

doi:10.1097/00000542-199404000-00004

Cited by 86 publications

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“…A recent observation [4] adds further to the debate. Halothane at 0.1 MAC did not significantly reduce the hypercapnic ventilatory response [4], which agrees with Knill et al [1,2] but is in contrast to Dahan et al's results [3].…”

supporting

confidence: 86%

“…Later authors disputed these observations and reported a dose-dependent reduction in the ventilation-CO 2 slope (for doses in the range of £ 0.2 MAC) [3]. One of the suggested reasons for the difference in results was that Knill et al [1,2] had used Read's rebreathing method to induce hypercapnia (the end-tidal PCO 2 rises progressively over several minutes as air, or oxygenenriched air, is rebreathed from a large bag), whereas Dahan et al [3] used step hypercapnia (end-tidal PCO 2 rises rapidly to the desired level within seconds). Subsequent studies have explored these observations [4][5][6][7][8][9][10][11][12][13][14].…”

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confidence: 99%

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Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review

Pandit

2005

Anaesthesia

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SummaryThis paper reviews published studies (identified by a Medline-assisted search) on the effect of £ 0.2 minimum alveolar concentration inhaled anaesthetic agents on the hypercapnic ventilatory response in healthy subjects. Each article was examined for the anaesthetic agent used, whether CO 2 was administered using a rebreathing or a steady state (step hypercapnia) technique, and subject arousal (by audiovisual stimulation or by pain). Analysis of variance was used to assess the influence of each of these factors on the standardised hypercapnic response (the hypercapnic ventilatory response in l.min )1 .kPa )1 in the presence of anaesthetic, expressed as a fraction of the response without anaesthetic). There were 21 separate studies embedded within 14 published articles. When considered together, the effect of anaesthetics on the hypercapnic ventilatory response was not significant (p = 0.089). Furthermore, when each agent was considered separately, no agent alone had a significant effect on the hypercapnic response. Neither subject arousal (p = 0.396) nor the method used to induce hypercapnia (p = 0.625) had any significant influence on the response. This suggests that the hypercapnic response is more resistant to the effects of anaesthetics than the hypoxic ventilatory response. These results indicate areas for future work. It would seem important to identify the cellular mechanisms which might underlie the difference in hypercapnic and hypoxic responses, and possible ways in which subject arousal might interact in the brain with the chemoreflexes.

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supporting

confidence: 86%

mentioning

confidence: 99%

Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review

Pandit

2005

Anaesthesia

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“…Anaesthetics, opioids, hypnotics, and benzodiazepines may also cause respiratory depression and thereby decrease minute ventilation. Studies have shown that halothane reduces the ventilatory response to hypoxemia and hypercapnia [34]. This depression is most likely secondary to a selective effect of halothane on the peripheral chemoreflex loop.…”

Section: G E N E R a L A N A E S T H E S I Amentioning

confidence: 99%

The prevalence of perioperative complications in patients with and without obstructive sleep apnoea: a prospective cohort study

Tatiana

Șandru

Belîi

2016

Rom J Anaesth Int Care

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“…Studies have shown that halothane reduces the ventilatory response to hypoxemia and hypercapnia in humans. 25,26 This depression is most likely secondary to a selective effect of halothane on the peripheral chemoreflex loop. Similarly, a subanesthetic dose of isoflurane has been shown to reduce the hypoxemic ventilatory response via peripheral chemoreceptors.…”

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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Effects of Subanesthetic Halothane on the Ventilatory Responses to Hypercapnia and Acute Hypoxia in Healthy Volunteers

Cited by 86 publications

References 0 publications

Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review

Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review

The prevalence of perioperative complications in patients with and without obstructive sleep apnoea: a prospective cohort study

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

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