Site of Selective Action of Halothane on the Peripheral Chemoreflex Pathway in Humans

Knill, R. L.; Clement, J. L.

doi:10.1097/00000542-198408000-00002

Cited by 64 publications

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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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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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“…These were excluded from the final analysis for the following reasons: one used an anaesthetic (N 2 O) dose of 0.4 MAC, which was higher than the inclusion criterion [17], the other six articles simply did not measure the hypercapnic ventilatory response [18][19][20][21][22][23]. There were no other reasons to reject articles which fulfilled the selection criteria.…”

Section: Data Acquisitionmentioning

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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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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“…Örneğin halotan, karotid cisimciklerdeki kemoreseptörle-rin periferal kontrolünü yok ederek ve santral sinir sistemindeki solunum merkezini baskılayarak ventilasyonu azaltır. Halotan, ayrıca diyafram ve interkostal kasların fonksiyonlarını baskıla-yarak ventilasyonu azaltır [18][19][20]. Cerrahi hastalarına tiyopental uygulanması sternotiroid ve sternohiyoid kaslarda tonik aktivite kaybına neden olmaktadır [21].…”

Section: Sedasyon Anestezi Ve Opioidlerin Etkisiunclassified

The Evaluation and Management of Sleep Disordered Breathing During Perioperative Period

Kıvanç¹

2015

Ann Clin Anal Med

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ÖzetObstrüktif uyku apne (OSA), uyku sırasında arteriyel oksijen satürasyonun-da azalma, tekrarlayan üst solunum yolu tıkanıklıkları, sempatik tonusta artış ve tekrarlayan uyanıklıklarla karakterize bir sendromdur. OSA, en sık görülen uyku ile ilişkili solunum bozukluğudur. Amerika Birleşik Devletlerde (ABD) orta yaşlı nüfusun erkeklerde %4 ve kadınlarda %2'sinde rastlanır. Buna rağmen hastaların önemli bir kısmı tanı almamış ve tedavi edilmemiştir. Tüm bu bulgular cerrahi işleme alınan OSA'lı olguların da önemli bölümünün tanı almadı-ğını açıkça göstermektedir. Bu nedenle hekimler yaygın görülen bu hastalığın işlem öncesi hızla tanınması için tarama yapmalı, böylelikle de uykuda solunum bozukluklarının neden olacağı anestezi riskinden hastalarını korumalı ve gerekli tedavi yöntemlerini uygulamalıdırlar. Anahtar KelimelerUykuda Solunum Bozukluğu; Obstrüktif Uyku Apne Sendromu; Perioperatif Değerlendirme Abstract Obstructive sleep apnea (OSA) is a syndrome defined frequently by decrease in arterial oxygen saturation, repeated upper airway obstruction episodes, increases in sympathetic output and tone, and repetitive arousals during sleep. OSA is the most common form of sleep-disordered breathing. In the United States, it has been estimated that 4% of middle aged males and 2% of middle aged females have OSA. Nevertheless the majority of patients who affect from OSA are undiagnosed and untreated. All these evidences imply that a prominent portion of OSA patients who undergo surgery will not be diagnosed and that the physicians must screen patients suspected of having sleep-disordered breathing to customize the anesthetic care and start necessary evaluations and therapy.

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Site of Selective Action of Halothane on the Peripheral Chemoreflex Pathway in Humans

Cited by 64 publications

References 0 publications

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

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

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

The Evaluation and Management of Sleep Disordered Breathing During Perioperative Period

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