Respiratory adverse events associated with deep propofol sedation during upper gastrointestinal procedures in children

Background/Aims: Upper airway stimulation with endoscopes and pH-impedance probes during deep propofol sedation confers unknown risk for associated respiratory adverse airway events. This report quantifies frequencies of such events and airway rescue interventions associated with Esophagogastroduodenoscopies (EGD) and multi-channel intraluminal acid detection impedance probe (MIIP) placements. Methods: This was a prospective observational study regarding occurrence of adverse respiratory events in 42 children undergoing propofol sedated EGDs and MIIP placements: Group 1. (n=21 EGDs), Group2 (n=21 EGDs before MIIP), Group 3. (n=21 during MIIP). Results: All procedures were successfully completed using deep propofol sedation. Respiratory events were transient and associated with no morbidity or mortality. Nearly half of each group experienced a respiratory event. “Partial airway obstruction” during 42 EGDs occurred in 28.6% and responded to simple airway interventions. “Complete airway obstruction” occurred during 1/42 EGDs and 2/21 MIIPs. Throughout MIIP placement, endoscopic visualization of the glottis was maintained and unnecessary stimulation of the glottis was avoided; nonetheless, complete airway obstruction occurred in 2/21. Advanced airway rescue maneuvers were not required in either instance. Conclusions: Respiratory adverse events commonly occurred during EGDs and MIIP placements. All events were successfully rescued by simple airway interventions.

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Neuropsychological Consequences of Sleep-Disordered Breathing

Cognitive and Behavioral Abnormalities of Pediatric Diseases ◽

10.1093/oso/9780195342680.003.0066 ◽

2010 ◽

Author(s):

Jennifer Janusz ◽

Ann Halbower

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Obstruction ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Fragmentation ◽

Primary Snoring ◽

Respiratory Events ◽

Obstructive Sleep ◽

Disordered Breathing

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

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Acute Upper-Airway Obstruction by a Lingual Thyroglossal Duct Cyst and Implications for Advanced Airway Management

Respiratory Care ◽

10.4187/respcare.02513 ◽

2013 ◽

Vol 59 (7) ◽

pp. e98-e102 ◽

Cited By ~ 3

Author(s):

K. O. Zimmerman ◽

S. R. Hupp ◽

A. Bourguet-Vincent ◽

E. A. Bressler ◽

E. M. Raynor ◽

...

Keyword(s):

Airway Management ◽

Airway Obstruction ◽

Upper Airway ◽

Thyroglossal Duct Cyst ◽

Upper Airway Obstruction ◽

Duct Cyst ◽

Thyroglossal Duct ◽

Advanced Airway

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Effects of upper airway stimulation on swallowing, gasping, and autoresuscitation in hypoxic mice

Journal of Applied Physiology ◽

10.1152/jappl.1996.80.2.472 ◽

1996 ◽

Vol 80 (2) ◽

pp. 472-477 ◽

Cited By ~ 25

Author(s):

A. Khurana ◽

B. T. Thach

Keyword(s):

Airway Obstruction ◽

Mechanical Stimulation ◽

Spontaneous Recovery ◽

Upper Airway ◽

Severe Hypoxia ◽

Upper Airway Stimulation ◽

Fluid Infusion ◽

Fluid Removal ◽

Swallowing Reflex ◽

Infusion Fluid

Severe hypoxia produces a state of neural depression known as hypoxic coma in which reflex activity is believed to be absent but from which spontaneous recovery (“autoresuscitation”) still can occur. We evaluated the swallowing reflex during hypoxic coma by employing mechanical and chemosensory stimuli. BALB/c mice were given 97% N2-3% CO2 to breathe. At onset of coma, a 0.05-ml bolus of saline or water was infused into the pharynx. Unlike mechanical stimulation (sham infusion), fluid infusion usually was followed by rapid swallowing, more so with water than with saline. This model allowed examination of interactions among swallowing, hypoxic gasping, airway fluid removal, and autoresuscitation. Compared with sham infusion, saline and water reduced gasping rate equally. Saline, however, prolonged the process of autoresuscitation more than did water, an effect possibly related to an observed increased retention of saline in the airway. Occasionally, mice failed to swallow after infusions, in which case airway obstruction during gasping and autoresuscitation failure was repeatedly observed. These studies suggest that the swallowing component of the laryngeal chemoreflex is present during hypoxic coma and that swallowing facilitates autoresuscitation when upper airway fluid is present.

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Airway management

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0042 ◽

2007 ◽

pp. 259-266

Keyword(s):

Tracheal Intubation ◽

Respiratory Tract ◽

Airway Management ◽

Airway Obstruction ◽

Failure Rate ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Positive Pressure ◽

High Failure Rate ◽

Advanced Airway

Aims of airway management 260 Upper airway obstruction 260 Airway manoeuvres 261 Ventilation 266 • To relieve upper airway obstruction. • To facilitate positive pressure ventilation. • To protect respiratory tract from aspiration of gastric contents. Upper airway obstruction is a commonly encountered emergency and is often relieved by simple basic airway manoeuvres. Although many patients will go on to require more advanced management (e.g. tracheal intubation), such procedures carry a high failure rate and should not be performed by inexperienced practitioners. However, it is still useful to have a good knowledge about advanced airway manoeuvres as it enables the non-anaesthetist to prepare some of the equipment needed and to assist during the procedure once expert help has arrived....

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Post-approval upper airway stimulation predictors of treatment effectiveness in the ADHERE registry

European Respiratory Journal ◽

10.1183/13993003.01405-2018 ◽

2018 ◽

Vol 53 (1) ◽

pp. 1801405 ◽

Cited By ~ 40

Author(s):

Clemens Heiser ◽

Armin Steffen ◽

Maurits Boon ◽

Benedikt Hofauer ◽

Karl Doghramji ◽

...

Keyword(s):

Patient Satisfaction ◽

Adverse Events ◽

Treatment Success ◽

Upper Airway ◽

The United States ◽

Final Visit ◽

Effective Treatment Option ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

Post Hoc

Upper airway stimulation (UAS) has been shown to reduce severity of obstructive sleep apnoea. The aim of this study was to identify predictors of UAS therapy response in an international multicentre registry.Patients who underwent UAS implantation in the United States and Germany were enrolled in an observational registry. Data collected included patient characteristics, apnoea/hypopnoea index (AHI), Epworth sleepiness scale (ESS), objective adherence, adverse events and patient satisfaction measures.Post hocunivariate and multiple logistic regression were performed to evaluate factors associated with treatment success.Between October 2016 and January 2018, 508 participants were enrolled from 14 centres. Median AHI was reduced from 34 to 7 events·h−1, median ESS reduced from 12 to 7 from baseline to final visit at 12-month post-implant. Inpost hocanalyses, for each 1-year increase in age, there was a 4% increase in odds of treatment success. For each 1-unit increase in body mass index (BMI), there was 9% reduced odds of treatment success. In the multivariable model, age persisted in serving as statistically significant predictor of treatment success.In a large multicentre international registry, UAS is an effective treatment option with high patient satisfaction and low adverse events. Increasing age and reduced BMI are predictors of treatment response.

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Adverse Events in Hypoglossal Nerve Stimulator Implantation: 5-Year Analysis of the FDA MAUDE Database

Otolaryngology ◽

10.1177/0194599820960069 ◽

2020 ◽

pp. 019459982096006

Author(s):

Nikhil Bellamkonda ◽

Travis Shiba ◽

Abie H. Mendelsohn

Keyword(s):

Adverse Events ◽

Large Scale ◽

Hypoglossal Nerve ◽

Upper Airway ◽

Perioperative Period ◽

Nerve Stimulator ◽

Upper Airway Stimulation ◽

Patient Reports ◽

Obstructive Sleep ◽

National Patient

Objective Use of hypoglossal nerve stimulator implantation has dramatically improved the surgical treatment of multilevel airway collapse during obstructive sleep apnea (OSA). Understanding causes of adverse events and their impact on patients undergoing stimulator implantation will help improve patient preparation and surgical practices to avoid future complications. Study Design This study is a retrospective review of the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, a publicly available voluntary reporting system. Setting National patient event database. Methods The MAUDE database was searched for reports associated with the terms “hypoglossal nerve stimulator” and “Inspire,” being the only currently FDA-approved system for upper airway stimulation for OSA. All records were searched with the events limited in dates between May 2014 and September 2019. Results A total of 132 patient reports were identified over the 5-year inclusion period, containing 134 adverse events. The reported adverse events resulted in 32 device revision procedures as well as 17 explantations. Device migration and infection were 2 of the most commonly reported adverse events. Complications not witnessed in previous large-scale clinical trials included pneumothorax, pleural effusion, and lead migration into the pleural space. Conclusion Previous data have demonstrated hypoglossal nerve stimulator implantation results in reliable OSA improvement. However, a number of technical difficulties and complications still exist during the perioperative period, which should be communicated to patients during the surgical consent process.

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