Supplemental Carbon Dioxide Stabilizes the Upper Airway in Volunteers Anesthetized with Propofol

Anesthesiology
Katarina Jennifer RuscicMatthias Eikermann

Abstract

Propofol impairs upper airway dilator muscle tone and increases upper airway collapsibility. Preclinical studies show that carbon dioxide decreases propofol-mediated respiratory depression. We studied whether elevation of end-tidal carbon dioxide (PETCO2) via carbon dioxide insufflation reverses the airway collapsibility (primary hypothesis) and impaired genioglossus muscle electromyogram that accompany propofol anesthesia. We present a prespecified, secondary analysis of previously published experiments in 12 volunteers breathing via a high-flow respiratory circuit used to control upper airway pressure under propofol anesthesia at two levels, with the deep level titrated to suppression of motor response. Ventilation, mask pressure, negative pharyngeal pressure, upper airway closing pressure, genioglossus electromyogram, bispectral index, and change in end-expiratory lung volume were measured as a function of elevation of PETCO2 above baseline and depth of propofol anesthesia. PETCO2 augmentation dose-dependently lowered upper airway closing pressure with a decrease of 3.1 cm H2O (95% CI, 2.2 to 3.9; P < 0.001) under deep anesthesia, indicating improved upper airway stability. In parallel, the phasic genioglossus electromyogram...Continue Reading

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Mar 23, 2017·Current Opinion in Anaesthesiology·Katarina J RuscicMatthias Eikermann

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Citations

Mar 5, 2019·F1000Research·Matthias EikermannJaideep Pandit
May 2, 2021·British Journal of Anaesthesia·Peter SanterMatthias Eikermann

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