Upper Airway Closure

Abrams, Jonathan T.; Horrow, Jan C.; Bennett, Joel A.; Riper, Daniel F. Van; Storella, R. J.

doi:10.1213/00000539-199609000-00034

Cited by 54 publications

(7 citation statements)

References 18 publications

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“…Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines (adrenaline and noradrenaline), this sympathetic stimulation results in tachycardia and elevation of blood pressure (1-7). Thus diverse classes of drugs and different techniques such as; local anesthetics, opioids, calcium channel blockers, short acting β-adrenergic blockers, and their combinations have been used to prevent hemodynamic responses induced by laryngoscopy and endotracheal intubation (8-14). The hypothetical background for the use of these methods for laryngoscopy and tracheal intubation is that these adjuvant measures may be able to decrease hemodynamic responses by blocking intense sympathetic discharge caused by stimulation of the upper airway.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia

Hassani

Movassaghi

Goodarzi³

et al. 2012

Anesth Pain

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BackgroundInduction of anesthesia and endotracheal intubation often creates a period of hemodynamic instability in hypertensive patients. Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines.ObjectivesThis trial aimed to evaluate and compare the efficacy of fentanyl and fentanyl plus lidocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation in hypertensive patients.Patients and MethodsWe conducted a prospective, randomized, double-blind trial in 37 patients with hypertension in the Rasoul-Akram Hospital, Tehran, Iran, from March to December 2011. The patients were randomly divided into two groups (fentanyl group and fentanyl plus lidocaine group). The fentanyl group received 2 mcg/kg and the fentanyl plus lidocaine group received 1.5mg lidocaine and 2mcg/kg fentanyl. Hemodynamic variables were recorded at baseline, after giving inductive anesthetic agents, and 1, 3 and 5 minutes after performing endotracheal intubation.ResultsWe evaluated 37 patients including 15 males (40.54%) and 22 females (59.46%), with a mean age of 56.08 ± 10.85 years. There were no significant differences between the two groups regarding; heart rate, systolic blood pressure and diastolic blood pressure before induction, 3 minutes before intubation and 1, 3 and 5 minutes after intubation.ConclusionsFentanyl and fentanyl plus lidocaine effectively decreased the hemodynamic response to tracheal intubation, however, neither fentanyl nor fentanyl plus lidocaine, could inhibit all hemodynamic responses, moreover fentanyl plus lidocaine was not more effective than fentanyl alone.

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Section: Introductionmentioning

confidence: 99%

Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia

Hassani

Movassaghi

Goodarzi³

et al. 2012

Anesth Pain

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“…Fentanyl and its analogues are known to cause reflex excitation of the recurrent laryngeal nerve (RLN) correlated with a large increase in the laryngeal resistance to airflow ( Willette et al, 1982 ) and closure of the glottis (vocal cords) and supraglottic structures ( Abrams et al, 1996 ; Bennet et al, 1997 ; Miner et al, 2021 ). The upper airway muscles play an important role in ventilation, by determining the upper airway patency and dynamically adapting the airway resistance to airflow ( Bautista and Dutschmann, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of fentanyls and other μ opioid receptor agonists on the electrical activity of respiratory muscles in the rat

Cavallo,

Kelly,

Henderson

et al. 2023

Front. Pharmacol.

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Introduction: Deaths due to overdose of fentanyls result primarily from depression of respiration. These potent opioids can also produce muscle rigidity in the diaphragm and the chest muscles, a phenomenon known as Wooden Chest Syndrome, which further limits ventilation.Methods: We have compared the depression of ventilation by fentanyl and morphine by directly measuring their ability to induce muscle rigidity using EMG recording from diaphragm and external and internal intercostal muscles, in the rat working heart-brainstem preparation.Results: At equipotent bradypnea-inducing concentrations fentanyl produced a greater increase in expiratory EMG amplitude than morphine in all three muscles examined. In order to understand whether this effect of fentanyl was a unique property of the phenylpiperidine chemical structure, or due to fentanyl’s high agonist intrinsic efficacy or its lipophilicity, we compared a variety of agonists with different properties at concentrations that were equipotent at producing bradypnea. We compared carfentanil and alfentanil (phenylpiperidines with relatively high efficacy and high to medium lipophilicity, respectively), norbuprenorphine (orvinolmorphinan with high efficacy and lipophilicity) and levorphanol (morphinan with relatively low efficacy and high lipophilicity).Discussion: We observed that, agonists with higher intrinsic efficacy were more likely to increase expiratory EMG amplitude (i.e., produce chest rigidity) than agonists with lower efficacy. Whereas lipophilicity and chemical structure did not appear to correlate with the ability to induce chest rigidity.

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“…Studies that have investigated relationships between opioids of upper airway collapsibility in the perioperative period have not used the gold-standard upper airway collapsibility (P crit ) method. [68][69][70] In one small, detailed physiology study that measured P crit in healthy individuals, naloxone infusion improved airway collapsibility. 12 This suggested a possible link between opioids and upper airway collapsibility.…”

Section: Upper Airway Collapsibilitymentioning

confidence: 99%

“…Postoperative opioid administration at high doses may worsen upper airway collapsibility, although there is conflicting evidence. Studies that have investigated relationships between opioids of upper airway collapsibility in the perioperative period have not used the gold-standard upper airway collapsibility (P crit ) method 68–70. In one small, detailed physiology study that measured P crit in healthy individuals, naloxone infusion improved airway collapsibility 12.…”

Section: Endotype-specific Effects Of Postoperative Risk Factorsmentioning

confidence: 99%