title: Bronchial mucus transport velocity in patients receiving propofol and remifentanil versus sevoflurane and remifentanil anesthesia.
abstract: Volatile anesthetics reduce ciliary beat frequency in vitro. It has been reported that impaired bronchial mucus transport velocity (BTV) is associated with significantly increased pulmonary complications. In this study, we sought to determine in vivo differences in BTV, comparing patients having total IV anesthesia (TIVA) with propofol and remifentanil to anesthesia with sevoflurane and remifentanil. Twenty-two patients scheduled for elective general surgery were randomized to one of two groups: TIVA (propofol/remifentanil) or SEVO (sevoflurane/remifentanil). Thirty minutes after tracheal intubation, BTV was assessed by fiberoptic observation of the movement of methylene blue dye applied to the dorsal surface of the right main bronchus. BTV was significantly reduced in the SEVO group compared with the TIVA group (mean, 1.5 +/- 0.7 [0-2.3] versus 4.8 +/- 2.1 [2.3-8.8] mm/min; P < 0.0001). Anesthesia with sevoflurane may lead to significantly impaired bronchociliary clearance in comparison to TIVA. This could have implications for perioperative pulmonary complications, in particular in patients at risk for pulmonary complications.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia. thomas.ledowski@health.wa.gov.au
authors.forename: Thomas
authors.initials: T
authors.lastname: Ledowski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paech
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Schug
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D001980:Bronchi / Q000187:drug effects* / Q000378:metabolism; D016009:Chi-Square Distribution; D004338:Drug Combinations; D006801:Humans; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D009093:Mucus / Q000187:drug effects* / Q000378:metabolism; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D000077149:Sevoflurane
chemical_list: D004338:Drug Combinations; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol