跳至主要内容

Respiratory Volume Monitoring to Assess the Effect of Airway Maneuvers on Ventilation during Upper Endoscopy

Read full paper at:
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51320#.VGRvPmfHRK0

Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.
Cite this paper
Holley, K. , Mathews, D. , Ladd, D. , Campana, L. and Schapiro, H. (2014) Respiratory Volume Monitoring to Assess the Effect of Airway Maneuvers on Ventilation during Upper Endoscopy. Open Journal of Anesthesiology, 4, 281-290. doi: 10.4236/ojanes.2014.411041. 
 

[1] Seeff, L.C., Richards, T.B., Shapiro, J.A., et al. (2004) How Many Endoscopies Are Performed for Colorectal Cancer Screening? Results from CDC’s Survey of Endoscopic Capacity. Gastroenterology, 127, 1670-1677.
http://dx.doi.org/10.1053/j.gastro.2004.09.051
[2] American Society for Gastrointestinal Surgery (2002) Guidelines for the Use of Deep Sedation and Anesthesia for GI Endoscopy. Gastrointestinal Endoscopy, 56, 613-617.
http://dx.doi.org/10.1016/S0016-5107(02)70104-1
[3] Mackenzie, N. and Grant, I.S. (1987) Propofol for Intravenous Sedation. Anaesthesia, 42, 3-6.
http://dx.doi.org/10.1111/j.1365-2044.1987.tb02936.x
[4] Faulx, A.L., Vela, S., Das, A., et al. (2005) The Changing Landscape of Practice Patterns Regarding Unsedated Endoscopy and Propofol Use: A National Web Survey. Gastrointestinal Endoscopy, 62, 9-15.
http://dx.doi.org/10.1016/S0016-5107(05)00518-3
[5] Hillman, D.R., Platt, P.R. and Eastwood, P.R. (2003) Upper Airway during Anesthesia. British Journal of Anaesthesia, 91, 31-39.
http://dx.doi.org/10.1093/bja/aeg126
[6] Taylor, M.B., Grounds, R.M., Mulrooney, P.D. and Morgan, M. (1986) Ventilatory Effects of Propofol during Induction of Anaesthesia. Anaesthesia, 41, 816-820.
http://dx.doi.org/10.1111/j.1365-2044.1986.tb13123.x
[7] Goodman, N.W., Black, A.M.S. and Carter, J.A. (1987) Some Ventilatory Effects of Propofol as a Sole Anaesthetic Agent. British Journal of Anaesthesia, 59, 1497-1503.
[8] Cote, G.A., Hovis, R.M., Ansstas, M.A., et al. (2010) Incidence of Sedation-Related Complications with Propofol Use during Advanced Endoscopic Procedures. Clinical Gasterenterology and Hepatology, 8, 137-142.
[9] Overdyk, F.J., Carter, R., Maddox, R.R., Callura, J., Herrin, A.E., et al. (2007) Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea during Patient-Controlled Analgesia. Anesthesia & Analgesia, 105, 412-418.
http://dx.doi.org/10.1213/01.ane.0000269489.26048.63
[10] Voscopoulos, C., Brayanov, J., Ladd, D., Lalli, M., Panasyuk, A., et al. (2013) Evaluation of a Novel Non-Invasive Respiration Monitor Providing Continuous Measurement of Minute Ventilation in Ambulatory Subjects in a Variety of Clinical Scenarios. Anesthesia & Analgesia, 117, 91-100.
http://dx.doi.org/10.1213/ANE.0b013e3182918098
[11] Du Bois, D. and Du Bois, E.F. (1916) A Formula to Estimate the Approximate Surface Area if Height and Weight Be Known. Archives of Internal Medicine, 17, 863-871.
http://dx.doi.org/10.1001/archinte.1916.00080130010002
[12] American Academy of Respiratory Care Protocol Committee (2003) AARC: Adult Mechanical Ventilator Protocols.
http://www.aarc.org/resources/protocol_resources/documents/general_vent.pdf
[13] Metzner, J. and Domino, K. (2011) Risk of Anesthesia Care in Remote Locations. APSF Newsletter.
http://www.apsf.org/newsletters/html/2011/spring/06_remotelocation.htm
[14] American Society of Anesthesiologists (2010) Standards for Basic Anesthetic Monitoring.
http://www.asahq.org/For-Healthcare-Professionals/Standards-
Guidelines-and-Statements.aspx
[15] Mimoz, O., Bernard, T., Gaucher, A., Fransca, D. and Debaene, B. (2012) Accuracy of Respiratory Rate Monitoring Using a Non-Invasive Acoustic Method after General Anaesthesia. British Journal of Anaesthesia, 108, 872-875.
http://dx.doi.org/10.1093/bja/aer510
[16] Ramsay, M., Usman, M., Lagow, E., Mendoza, M., Untalan, E., et al. (2013) The Accuracy, Precision and Reliability of Measuring Ventilatory Rate and Detecting Ventilatory Pause by Rainbow Acoustic Monitoring and Capnometry. Anesthesia and Analgesia, 117, 69-75.
http://dx.doi.org/10.1213/ANE.0b013e318290c798              eww141113lx
标签：

评论

发表评论

此博客中的热门博文

Does Immigration Promote the Investment of the Monopolistic Firm?

In the present paper, we examine the effect of increasing uncertainty of immigrants’ growth on the optimal timing of investment of a firm that has a monopolistic power over the labor market. It is revealed that when the uncertainty of immigrants’ growth is more than a threshold level, increasing uncertainty of immigrants’ growth accelerates the optimal timing of firms’ investment and enhances the economic growth, even if the uncertainty of immigrants’ growth is formulated by the geometric Brownian motion, which is in sharp contrast to the standard result that an increase in the uncertainty postpones the optimal timing. With an increase in the immigrants over the past ten years, workforces in the host countries have been growing significantly to the extent that the immigrants represent 70% of the increase in the workforce in Europe, and 47% in the United States as OECD indicates. In the present paper, we attempted to investigate the effect of increased uncertainty caused by the growi...
发表评论
阅读全文

Education Policy Implementation: A Mechanism for Enhancing Primary Education Development in Zanzibar

Education is one of the fundamental rights of individuals; therefore, the government of a country needs to develop and strengthen educational policy and quality as well as to ensure that everyone has equal access to basic education. The improvement of access and quality of education in the world is becoming as an essential factor in development, whereas the basic education (primary school), is acknowledged as a foundation of the higher educational development for every country. To fulfill this goal, governments introduce several policies and procedures; however, it requires some reforms and participation from the politician, policymakers, and other stakeholders to re-examine educational policy so that it can lead to multiplication and betterment of the reforms. Educational reforms actually focus on accountability. A positive educational development and reform is very challenging and needs more effort and strategy on how to use and utilize the resources effectively as such it can achie...
发表评论
阅读全文