The effect of sevoflurane and desflurane on upper airway reactivity.
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.
Klock
P A
PA
Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA. aklock@airway2.uchicago.edu
Czeslick
E G
EG
Klafta
J M
JM
Ovassapian
A
A
Moss
J
J
D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000187:drug effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000077335:Desflurane; D004311:Double-Blind Method; D004558:Electric Stimulation; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000009:adverse effects* / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000378:metabolism; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D000077149:Sevoflurane; D014132:Trachea / Q000187:drug effects*
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane