The effect of sevoflurane and desflurane on upper airway reactivity.
Author(s): Klock PA Jr, Czeslick EG, Klafta JM, Ovassapian A, Moss J.
Affiliation(s): Department of Anesthesia and Critical Care, University of Chicago, Illinois
60637, USA. aklock@airway2.uchicago.edu
Publication date & source: 2001, Anesthesiology. , 94(6):963-7
BACKGROUND: Although bronchial reactivity can be assessed by changes in airway
resistance, there is no well-accepted measure of upper airway reactivity during
anesthesia. The authors used the stimulus of endotracheal tube cuff inflation and
deflation to assess changes in airway reactivity in patients anesthetized with
sevoflurane and desflurane.
METHODS: Sixty-four patients classified as American Society of Anesthesiologists
physical status I or II participated in this randomized, double-blind study.
Patients were anesthetized with either sevoflurane or desflurane at 1.0 and 1.8
minimum alveolar concentration (MAC). The trachea was stimulated by inflating the
endotracheal tube cuff. A blinded observer assessed the severity of patient
response to the stimulus and changes in hemodynamic variables. The process was
repeated at the second MAC treatment condition.
RESULTS: At 1.0 MAC, patients anesthetized with desflurane had a more intense
response and a greater likelihood of significant coughing and associated
hemodynamic changes (both at P < 0.05). At 1.8 MAC, sevoflurane and desflurane
both suppressed clinically significant responses to tracheal stimulation.
Interrater reliability was excellent for this measure of upper airway reactivity
(P < 0.001).
CONCLUSIONS: The assessment of the cough response to tracheal stimulation by
endotracheal tube cuff inflation is a reliable and clinically meaningful measure
of upper airway reactivity. At 1.0 MAC, sevoflurane is superior to desflurane for
suppressing moderate and severe responses to this stimulus.
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