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Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers

BACKGROUND: Ketamine is a potent sedative drug that helps to maintain upper‐airway patency, due to its higher upper‐airway dilator muscular activity and higher level of duty cycle, as seen in rats. However, no clinical trials have tested passive upper‐airway collapsibility and changes in the inspira...

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Autores principales: Mishima, Gaku, Sanuki, Takuro, Sato, Shuntaro, Kobayashi, Masato, Kurata, Shinji, Ayuse, Takao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243198/
https://www.ncbi.nlm.nih.gov/pubmed/32441458
http://dx.doi.org/10.14814/phy2.14439
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author Mishima, Gaku
Sanuki, Takuro
Sato, Shuntaro
Kobayashi, Masato
Kurata, Shinji
Ayuse, Takao
author_facet Mishima, Gaku
Sanuki, Takuro
Sato, Shuntaro
Kobayashi, Masato
Kurata, Shinji
Ayuse, Takao
author_sort Mishima, Gaku
collection PubMed
description BACKGROUND: Ketamine is a potent sedative drug that helps to maintain upper‐airway patency, due to its higher upper‐airway dilator muscular activity and higher level of duty cycle, as seen in rats. However, no clinical trials have tested passive upper‐airway collapsibility and changes in the inspiratory duty cycle against partial upper‐airway obstruction in humans. The present study evaluated both the passive mechanical upper‐airway collapsibility and compensatory response against acute partial upper‐airway obstruction using three different sedative drugs in a crossover trial. METHODS: Eight male volunteers entered this nonblinded, randomized crossover study. Upper‐airway collapsibility (passive critical closing pressure) and inspiratory duty cycle were measured under moderate sedation with ketamine, propofol, and dexmedetomidine. Propofol, dexmedetomidine, and ketamine anesthesia were induced to obtain adequate, same‐level sedation, with a BIS value of 50–70 and the OAA/S score of 2–3 and RASS score of −3. RESULTS: The median passive critical closing pressure of 0.08 [−5.51 to 1.20] cm H(2)O was not significantly different compared to that of propofol sedation (−0.32 [−1.41 to −0.19] cm H(2)O) and of dexmedetomidine sedation (−0.28 [−0.95 to −0.03] cm H(2)O) (p = .045). The median passive R (US) for ketamine 54.35 [32.00 to 117.50] cm H(2)O/L/s was significantly higher than that for propofol 5.50 [2.475 to 19.60] cm H(2)O/L/s; (mean difference, 27.50; 95% CI 9.17 to 45.83) (p = .009) and for dexmedetomidine 19.25 [4.125 to 22.05] cm H(2)O/L/s; (mean difference, 22.88; 95% CI 4.67 to 41.09) (p = .021). The inspiratory duty cycle increased significantly as the inspiratory airflow decreased in passive conditions for each sedative drug, but behavior differed among the three sedative drugs. CONCLUSION: Our findings demonstrate that ketamine sedation may have an advantage of both maintained passive upper‐airway collapsibility and a compensatory respiratory response, due to both increase in neuromuscular activity and the increased duty cycle, to acute partial upper‐airway obstruction.
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spelling pubmed-72431982020-06-01 Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers Mishima, Gaku Sanuki, Takuro Sato, Shuntaro Kobayashi, Masato Kurata, Shinji Ayuse, Takao Physiol Rep Original Research BACKGROUND: Ketamine is a potent sedative drug that helps to maintain upper‐airway patency, due to its higher upper‐airway dilator muscular activity and higher level of duty cycle, as seen in rats. However, no clinical trials have tested passive upper‐airway collapsibility and changes in the inspiratory duty cycle against partial upper‐airway obstruction in humans. The present study evaluated both the passive mechanical upper‐airway collapsibility and compensatory response against acute partial upper‐airway obstruction using three different sedative drugs in a crossover trial. METHODS: Eight male volunteers entered this nonblinded, randomized crossover study. Upper‐airway collapsibility (passive critical closing pressure) and inspiratory duty cycle were measured under moderate sedation with ketamine, propofol, and dexmedetomidine. Propofol, dexmedetomidine, and ketamine anesthesia were induced to obtain adequate, same‐level sedation, with a BIS value of 50–70 and the OAA/S score of 2–3 and RASS score of −3. RESULTS: The median passive critical closing pressure of 0.08 [−5.51 to 1.20] cm H(2)O was not significantly different compared to that of propofol sedation (−0.32 [−1.41 to −0.19] cm H(2)O) and of dexmedetomidine sedation (−0.28 [−0.95 to −0.03] cm H(2)O) (p = .045). The median passive R (US) for ketamine 54.35 [32.00 to 117.50] cm H(2)O/L/s was significantly higher than that for propofol 5.50 [2.475 to 19.60] cm H(2)O/L/s; (mean difference, 27.50; 95% CI 9.17 to 45.83) (p = .009) and for dexmedetomidine 19.25 [4.125 to 22.05] cm H(2)O/L/s; (mean difference, 22.88; 95% CI 4.67 to 41.09) (p = .021). The inspiratory duty cycle increased significantly as the inspiratory airflow decreased in passive conditions for each sedative drug, but behavior differed among the three sedative drugs. CONCLUSION: Our findings demonstrate that ketamine sedation may have an advantage of both maintained passive upper‐airway collapsibility and a compensatory respiratory response, due to both increase in neuromuscular activity and the increased duty cycle, to acute partial upper‐airway obstruction. John Wiley and Sons Inc. 2020-05-22 /pmc/articles/PMC7243198/ /pubmed/32441458 http://dx.doi.org/10.14814/phy2.14439 Text en © 2020 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Mishima, Gaku
Sanuki, Takuro
Sato, Shuntaro
Kobayashi, Masato
Kurata, Shinji
Ayuse, Takao
Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title_full Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title_fullStr Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title_full_unstemmed Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title_short Upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
title_sort upper‐airway collapsibility and compensatory responses under moderate sedation with ketamine, dexmedetomidine, and propofol in healthy volunteers
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243198/
https://www.ncbi.nlm.nih.gov/pubmed/32441458
http://dx.doi.org/10.14814/phy2.14439
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