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Zheng Y, Xiong B, Sang A, Liu X, Li X, Song X. Bispectral Index versus the University of Michigan Sedation Scale in assessing sedation depth during pediatric drug-induced sleep endoscopy. Sleep Breath 2024; 28:1365-1372. [PMID: 38499834 DOI: 10.1007/s11325-024-03022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND PURPOSE Bispectral Index (BIS) and University of Michigan Sedation Scale (UMSS) were two commonly used methods of monitoring the sedation depth, but their correlation was not clear. The purpose of this study is to ascertain if BIS correlates with UMSS in determining the sedation level during pediatric drug-induced sleep endoscopy (DISE). METHODS One-hundred children, aged 36-143 months, with ASA I~II grade, were enrolled. They were subject to general anesthesia for an elective adenotonsillectomy. Two drug regimens were used. After UMSS ≥ 3, the sites of airway obstructions were located by checking the supraglottic airway structures with a fibrous laryngoscope. UMSS scores, BIS values, electromyography (EMG), and signal quality indices (SQIs) were recorded at the pre-medication and pre-DISE baseline (T0), 5 min subsequent to medication administration but prior to DISE initiation (T1), 1 min after DISE was initiated (T2), 1 min after DISE was completed (T3), 1 min subsequent to tracheal intubation (T4), 1 min following extubation (T5), and 30 min past extubation (T6). RESULTS There were strong correlations between BIS monitor readings and UMSS scores for total and two regimens. Kappa values revealed moderate agreement between BIS and UMSS for total and two regimens. The agreement rates were 67.47% for the total, 61.43% for Regimen 1, and 73.42% for Regimen 2, respectively. CONCLUSION BIS correlates with UMSS in determining the sedation level during pediatric DISE for two regimens. BIS might serve as an appropriate indicator of sedation intensity when UMSS could not be used.
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Affiliation(s)
- Yongping Zheng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Bingrui Xiong
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Aming Sang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaorong Liu
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xinyi Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Xuemin Song
- Research Centre of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Polievoi Y, Grafmans D, Skliar M, Kossatz A, Soukup J, Kellner P, Herzog B, Herzog M. The influence of different application patterns of propofol on the sedation courses during drug-induced sleep endoscopy. Laryngoscope Investig Otolaryngol 2024; 9:e1258. [PMID: 38887705 PMCID: PMC11181130 DOI: 10.1002/lio2.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/21/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024] Open
Abstract
Objective The course of sedation during drug-induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation. Methods Sixty-three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed. Results The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea-hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation. Conclusion Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation-controlled DISE. Level of evidence 2: Randomized trial.
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Affiliation(s)
- Yehor Polievoi
- Department of Otorhinolaryngology, Head and Neck SurgeryCarl‐Thiem‐Klinikum gGmbHCottbusGermany
- Department of Otorhinolaryngology, Head and Neck SurgeryKlinikum Barnim, Werner‐Forßmann‐KrankenhausEberswaldeGermany
| | - Daniel Grafmans
- Department of Otorhinolaryngology, Head and Neck SurgeryCarl‐Thiem‐Klinikum gGmbHCottbusGermany
| | - Mariia Skliar
- Department of Otorhinolaryngology, Head and Neck SurgeryCarl‐Thiem‐Klinikum gGmbHCottbusGermany
| | - Andrea Kossatz
- Department of Anesthesiology, Intensive Care and Palliative MedicineCarl‐Thiem‐Klinikum gGmbHCottbusGermany
| | - Jens Soukup
- Department of Anesthesiology, Intensive Care and Palliative MedicineCarl‐Thiem‐Klinikum gGmbHCottbusGermany
- Department of Anesthesiology and Intensive Care MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Patrick Kellner
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Schleswig Holstein, Campus LubeckLübeckGermany
| | - Beatrice Herzog
- Clinical and Epidemiological Cancer Registry Berlin/BrandenburgCottbusGermany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck SurgeryCarl‐Thiem‐Klinikum gGmbHCottbusGermany
- Department of Otorhinolaryngology, Head and Neck SurgeryMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
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Lackey TG, Duffy JR, Green KK. A Protocol for Propofol-Infusion Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2023; 168:234-240. [PMID: 35349363 DOI: 10.1177/01945998221088760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to outline a protocol utilizing propofol infusion without an initial bolus during drug-induced sleep endoscopy (DISE). We define normative values for final propofol infusion rate (Pfinal ) during DISE and sedation depth values at Pfinal . STUDY DESIGN Retrospective chart review. SETTING Tertiary academic hospital. METHODS A review of patients with obstructive sleep apnea who underwent DISE between 2016 and 2020 was performed. The following patient data were recorded: demographics; DISE procedure details, including Pfinal , time to Pfinal , frequency and cadence of infusion rate changes, depth of sedation as measured by Bispectral Index and SedLine values, and hemodynamics; and polysomnography details including apnea-hypopnea index severity and minimum oxygen saturation. A mixed linear model adjusted for age and body mass index was performed for the analysis of effects on Pfinal . Pearson correlation coefficients determined the strength of association between depth of sedation measured and pattern of collapse on DISE and Pfinal . RESULTS There were 246 patients who met inclusion criteria. Pfinal resembled a normal distribution (mean ± SD, 156.44 ± 26.69 mcg/kg/min; median, 150 mcg/kg/min). Analysis demonstrated that Pfinal was influenced by male sex, current smoker status, time to Pfinal , and number of propofol dose changes (P < .05). Depth of sedation categories measured differently between Bispectral Index and SedLine (55-65 vs 45-55, P < .001). The pattern including severity of collapse on DISE was not associated with Pfinal (P > .05). No patients required intra- or postoperative respiratory support beyond oxygen via nasal canula. CONCLUSION We describe a propofol slow-infusion DISE protocol that demonstrates safe and reproducible outcomes.
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Affiliation(s)
- Taylor G Lackey
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | - James R Duffy
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Katherine K Green
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Denver, Aurora, Colorado, USA
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Yongping Z, Xinyi L, Aming S, Qiang X, Tianqi Z, Mengmeng S, Xiong C, Xuemin S. The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial. Front Pharmacol 2022; 13:1036509. [PMID: 36532775 PMCID: PMC9751969 DOI: 10.3389/fphar.2022.1036509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/18/2022] [Indexed: 10/03/2023] Open
Abstract
Background and Purpose: Data and high-quality studies of anesthetic methods for children with obstructive sleep apnea hypopnea syndrome (OSAHS) who undergo drug-induced sleep endoscopy (DISE) are limited. Research on pediatric DISE using esketamine has never been reported before. To test the safety and efficacy of esketamine during DISE in children with OSAHS, we compare esketamine (Group K) with dexmedetomidine (Group D) in this study. Methods: 100 children with ASA Ⅰ∼Ⅱ grade, prepared for an elective adenotonsillectomy under general anesthesia, were enrolled in this study and randomized into two groups. Midazolam 0.1 mg/kg was administered intravenously for both groups. In Group D a 1 μg/kg bolus of dexmedetomidine was given over 10 min followed by the infusion rate 1 μg/kg/hr to the end of DISE. Group K received a 1.0 mg/kg IV bolus of esketamine over 10 s followed by the infusion rate 1 mg/kg/hr to the end of DISE. Results: Group K had a higher percentage of success than Group D (p = 0.008). The onset time of Group K was shorter than that of Group D (p = 0.000). The University of Michigan Sedation Scale (UMSS) score of Group K was higher than that of Group D (p = 0.005). The risk of adverse effects (AEs) was lower in Group K (p = 0.000). In Group D, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) all decreased, while in Group K, SBP, DBP, and HR hardly changed. Conclusion: Esketamine in comparison to dexmedetomidine provides more effective and safer depth of anesthesia for OSAHS pediatric DISE by ensuring short onset time, deep sedation, and few AEs. Clinical Trial Registration: ClincalTrials.gov, identifier NCT04877639.
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Affiliation(s)
- Zheng Yongping
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Li Xinyi
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sang Aming
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xie Qiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhou Tianqi
- Postanesthesia Care Unit, Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shen Mengmeng
- Postanesthesia Care Unit, Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chen Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Song Xuemin
- Department of Anesthesiology, Research Centre of Anesthesiology and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Padiyara TV, Bansal S, Jain D, Arora S, Gandhi K. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: A randomized trial. Laryngoscope 2019; 130:257-262. [PMID: 30821349 DOI: 10.1002/lary.27903] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to compare the effect of dexmedetomidine and propofol on airway dynamics, cardiorespiratory system, and emergence following drug-induced sleep endoscopy (DISE). STUDY DESIGN Prospective, randomized, single-blinded study. METHODS Sixty patients age 18 to 65 years in American Society of Anesthesiologists physical status groups 1 and 2 scheduled to undergo DISE were randomly allocated to either Group P (N = 30; receiving propofol infusion at 50-150 μg/kg/min) or Group D (N = 30; receiving dexmedetomidine bolus of 1 μg/kg followed by infusion at 0.5-1.0 μg/kg/hr). DISE was done at light sleep and deep sleep. Airway obstruction at tongue base was recorded as primary outcome. Airway obstruction at velum, oropharyngeal lateral wall, and epiglottis level during light and deep sedation, hemodynamic and respiratory parameters, time to attain sufficient sedation, time for emergence from sedation, and any adverse events during DISE with the two study drugs were recorded as secondary outcomes. RESULTS There was a greater degree of obstruction at the tongue base level (P = 0.001) and Oropharynx level (P = 0.017) in Group P compared with Group D during deep sedation. Increase in airway obstruction from light to deep sleep was seen with propofol at the oropharynx (P = 0.0185) and tongue base (P = 0.0108) levels. Two patients (6.6%) in Group D and 10 patients (33.3%) in Group P showed oxygen saturation below the minimum oxygen saturation recorded during polysomnography. Time to open eyes to call after stopping sedation was significantly less in Group P (P = 0.005). CONCLUSIONS Dexmedetomidine shows a lesser degree of airway collapse and higher oxygen saturation levels at greater sedation depth during DISE. Propofol has a faster onset and emergence from sedation. LEVEL OF EVIDENCE 1b Laryngoscope, 130:257-262, 2020.
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Affiliation(s)
- Tonsy V Padiyara
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suman Arora
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Gandhi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Subglottic stenosis refers to narrowing of the airway diameter below the vocal folds and may be congenital or acquired. Typical signs and symptoms range from recurrent croup and exertional stridor to complete airflow obstruction requiring tracheotomy. Management of moderate and severe subglottic stenosis often requires intricate surgical techniques. To optimize the success of these surgeries, a thorough assessment of the child's airway, lungs, reflux, and swallow needs to be evaluated. In order to provide concerted and coordinated care between typically otolaryngology (ENT), pulmonary, gastroenterology (GI), speech, swallow and language pathologists (SLP), "aerodigestive" teams have been developed and increasing in prevalence at children's medical hospitals. This article sets out to provide a brief overview of an aerodigestive program and evaluation, review a few of the more common laryngotracheal conditions, and the surgical techniques involved to augment the airway.
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Affiliation(s)
- Katherine Hanlon
- The Center for Pediatric Airway Disorders, Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - R Paul Boesch
- Mayo Clinic, Children's Center, Pediatric and Adolescent Medicine, Rochester, MN
| | - Ian Jacobs
- The Center for Pediatric Airway Disorders, Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Oh MS, Dedhia RC. Current Techniques and Role of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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