title: Upper airway obstruction during midazolam sedation: modification by nasal CPAP.
abstract: We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to < 90% or snoring and/or apnoea was observed, continuous positive airway pressure applied through the nose (nasal CPAP) was increased until the respiratory deterioration was reversed. While one patient remained free of respiratory events, the other 20 patients were successfully treated with nasal CPAP restoring normal SpO2 (95.5 +/- 1.7%) without snoring. Stepwise reduction of nasal CPAP determined the minimally effective CPAP to prevent snoring to be 5.1 +/- 2.1 cm H2O. Further reduction of nasal CPAP induced snoring in 15 patients and obstructive apnoea in five patients with the latter accompanied by a severe reduction of SpO2 (87.4 +/- 6.1%). Patients with apnoea were older than those who snored (P < 0.05. We conclude that upper airway obstruction contributes considerably to decreases in SpO2 during midazolam sedation for spinal anaesthesia.
authors.affiliation: Department of Anaesthesia, Funabashi Municipal Medical Centre, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nozaki-Taguchi
authors.forename: S
authors.initials: S
authors.lastname: Isono
authors.forename: T
authors.initials: T
authors.lastname: Nishino
authors.forename: T
authors.initials: T
authors.lastname: Numai
authors.forename: N
authors.initials: N
authors.lastname: Taguchi
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000402:Airway Obstruction / Q000139:chemically induced* / Q000628:therapy*; D000775:Anesthesia, Spinal; D001049:Apnea / Q000139:chemically induced / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007275:Injections, Intravenous; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010423:Pentazocine / Q000008:administration & dosage; D011175:Positive-Pressure Respiration / Q000379:methods*; D011312:Pressure; D012123:Pulmonary Ventilation / Q000187:drug effects; D012119:Respiration / Q000187:drug effects; D012913:Snoring / Q000139:chemically induced / Q000628:therapy
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D010423:Pentazocine; D010100:Oxygen