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BMC Anesthesiology

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Open Access 01-12-2018 | Research article

Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial

Authors: Hyun-Jung Shin, Eun-Young Kim, Jung-Won Hwang, Sang-Hwan Do, Hyo-Seok Na

Published in: BMC Anesthesiology | Issue 1/2018

Abstract

Background

In addition to propofol, dexmedetomidine is a suitable alternative for intraoperative sedation in procedures requiring regional anesthesia. To date, however, little is known about the influences of each drug on upper airway patency. Accordingly, the authors investigated differences between dexmedetomidine and propofol sedation in the occurrence of upper airway obstruction and requirements for airway intervention in patients with mild obstructive sleep apnea.

Methods

Patients with an apnea/hypopnea index of 5–14/h according to Watch-PAT 200 analysis were enrolled in this study. Spinal anesthesia was routinely performed for surgery. Intraoperative sedation was initiated using either dexmedetomidine or propofol infusion at a level of modified observer’s assessment of alertness/sedation scale 3. The primary outcome was the proportion of patients exhibiting signs of upper airway obstruction. A sign of upper airway obstruction was defined as no detection of end-tidal carbon dioxide for at least 10 s despite respiratory efforts.

Results

A total of 50 patients were included in the final analysis (dexmedetomidine [n = 26]; propofol [n = 24]). During the intraoperative sedation period, there was a significantly lower proportion of patients exhibiting signs of upper airway obstruction in the dexmedetomidine group than in the propofol group (11.5% vs. 41.7%, P = 0.035). An artificial airway was inserted in 1 patients (3.8%) and 5 patient (20.8%) in the dexmedetomidine and propofol groups, respectively (P = 0.093).

Conclusion

Dexmedetomidine sedation was associated with a lower incidence of upper airway obstruction than propofol sedation in patients with mild obstructive sleep apnea.

Trial registration number

Clinical trials.gov (NCT02993718): Retrospectively registered.

Becker DE, Haas DA. Management of complications during moderate and deep sedation: respiratory and cardiovascular considerations. Anesth Prog. 2007;54(2):59–68.CrossRefPubMedPubMedCentral

Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation part 1: respiratory considerations. Anesth Prog. 2011;58(2):82–92.CrossRefPubMedPubMedCentral

Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth. 2009;56(11):819–28.CrossRefPubMed

Mador MJ, Goplani S, Gottumukkala VA, El-Solh AA, Akashdeep K, Khadka G, Abo-Khamis M. Postoperative complications in obstructive sleep apnea. Sleep Breath. 2013;17(2):727–34.CrossRefPubMed

Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90(3):699–705.CrossRefPubMed

Na HS, Song IA, Park HS, Hwang JW, Do SH, Kim CS. Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery. Korean J Anesthesiol. 2011;61(6):453–9.CrossRefPubMedPubMedCentral

Ryu JH, Lee SW, Lee JH, Lee EH, Do SH, Kim CS. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth. 2012;108(3):503–11.CrossRefPubMed

Nishizawa T, Suzuki H, Sagara S, Kanai T, Yahagi N. Dexmedetomidine versus midazolam for gastrointestinal endoscopy: a meta-analysis. Dig Endosc. 2015;27(1):8–15.CrossRefPubMed

Huupponen E, Maksimow A, Lapinlampi P, Sarkela M, Saastamoinen A, Snapir A, Scheinin H, Scheinin M, Merilainen P, Himanen SL, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiol Scand. 2008;52(2):289–94.CrossRefPubMed

10.

Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, Young CC, Wright DR, Macleod DB, Somma J. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101(5):1066–76.CrossRefPubMed

11.

Lee MH, Yang KH, Lee CS, Lee HS, Moon SY, Hwang SI, Song JH. The effect-site concentration of propofol producing respiratory depression during spinal anesthesia. Korean journal of anesthesiology. 2011;61(2):122–6.CrossRefPubMedPubMedCentral

12.

Peacock JE, Luntley JB, O'Connor B, Reilly CS, Ogg TW, Watson BJ, Shaikh S. Remifentanil in combination with propofol for spontaneous ventilation anaesthesia. Br J Anaesth. 1998;80(4):509–11.CrossRefPubMed

13.

Mahmoud M, Ishman SL, McConnell K, Fleck R, Shott S, Mylavarapu G, Gutmark E, Zou Y, Szczesniak R, Amin RS. Upper airway reflexes are preserved during Dexmedetomidine sedation in children with Down syndrome and obstructive sleep apnea. J Clin Sleep Med. 2017;13(5):721–7.CrossRefPubMedPubMedCentral

14.

Pang KP, Gourin CG, Terris DJ. A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;137(4):665–8.CrossRefPubMed

15.

Hohener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth. 2008;100(1):8–16.CrossRefPubMed

16.

Mingir T, Ervatan Z, Turgut N. Spinal Anaesthesia and perioperative anxiety. Turk J Anaesthesiol Reanim. 2014;42(4):190–5.CrossRefPubMedPubMedCentral

17.

Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med. 2012;8(2):199–207.PubMedPubMedCentral

18.

Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141(2):436–41.CrossRefPubMed

19.

Peng K, Li J, Ji FH, Li Z. Dexmedetomidine compared with propofol for pediatric sedation during cerebral angiography. J Res Med Sci. 2014;19(6):549–54.PubMedPubMedCentral

20.

Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhasivam S. A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesth Analg. 2009;109(3):745–53.CrossRefPubMed

21.

Mahmoud M, Radhakrishman R, Gunter J, Sadhasivam S, Schapiro A, McAuliffe J, Kurth D, Wang Y, Nick TG, Donnelly LF. Effect of increasing depth of dexmedetomidine anesthesia on upper airway morphology in children. Paediatr Anaesth. 2010;20(6):506–15.CrossRefPubMed

22.

Watt S, Sabouri S, Hegazy R, Gupta P, Heard C. Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation? J Clin Anesth. 2016;35:259–67.CrossRefPubMed

23.

Mathru M, Esch O, Lang J, Herbert ME, Chaljub G, Goodacre B, vanSonnenberg E. Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology. 1996;84(2):273–9.CrossRefPubMed

24.

Sundman E, Witt H, Sandin R, Kuylenstierna R, Boden K, Ekberg O, Eriksson LI. Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry. Anesthesiology. 2001;95(5):1125–32.CrossRefPubMed

25.

Mahmoud M, Jung D, Salisbury S, McAuliffe J, Gunter J, Patio M, Donnelly LF, Fleck R. Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea. J Clin Anesth. 2013;25(7):529–41.CrossRefPubMed

26.

Eastwood PR, Szollosi I, Platt PR, Hillman DR. Comparison of upper airway collapse during general anaesthesia and sleep. Lancet (London, England). 2002;359(9313):1207–9.CrossRef

27.

Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;95(2):461–6. table of contentsPubMed

28.

Shah PJ, Dubey KP, Sahare KK, Agrawal A. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: a comparative study. J Anaesthesiol Clin Pharmacol. 2016;32(2):245–9.CrossRefPubMedPubMedCentral

29.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II Hemodynamic changes. Anesthesiology. 1992;77(6):1134–42.CrossRefPubMed

30.

Goodchild CS, Serrao JM. Propofol-induced cardiovascular depression: science and art. Br J Anaesth. 2015;115(4):641–2.CrossRefPubMed

Title: Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial
Authors: Hyun-Jung Shin
Eun-Young Kim
Jung-Won Hwang
Sang-Hwan Do
Hyo-Seok Na
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-018-0586-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial

Abstract

Background

Methods

Results

Conclusion

Trial registration number

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration number

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