Abdominal relaxation during emergence from general anesthesia with propofol and remifentanil.
OBJECTIVE
To characterize respiratory dynamics during emergence from propofol-remifentanil anesthesia using noninvasive respiratory inductance plethysmography (RIP).


METHODS
Observational pilot study.


METHODS
Operating room in a university-affiliated teaching hospital.


METHODS
50 ASA physical status 1, 2, and 3 patients scheduled for microdirect laryngoscopy or bronchoscopy using total intravenous anesthesia (TIVA) with high-frequency jet ventilation.


METHODS
Patients were fitted with plethysmography bands around the chest and abdomen prior to induction. Following completion of surgery in patients undergoing brief airway procedures using propofol-remifentanil general anesthesia, the anesthetic infusions were stopped and ventilation suspended until resumption of spontaneous ventilation or desaturation below 90%. During this period of apnea, abdominal and thoracic girth was assessed with noninvasive RIP.


METHODS
Cross-sectional area of the thorax and abdomen during emergence were measured.


RESULTS
Useful data were obtained from 41 patients, with stable apnea lasting 404 ± 193.1 seconds; of these, 34 exhibited a slow and significant decrease in abdominal girth over a period of 267.8 ± 128.5 seconds. Resumption of spontaneous ventilation generally coincided with the end of this abdominal relaxation.


CONCLUSIONS
Slow expiration is the initial step in the resumption of spontaneous ventilation during apnea induced with TIVA using propofol-remifentanil.
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. atkinsj@uphs.upenn.edu
Joshua H
JH
Atkins
Jeff E
JE
Mandel
D000009:Abdominal Muscles / Q000187:drug effects* / Q000502:physiology; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous / Q000379:methods; D019162:Anesthetics, Combined / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001049:Apnea / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D001999:Bronchoscopy; D045853:Exhalation / Q000502:physiology; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007828:Laryngoscopy; D008991:Monitoring, Physiologic / Q000379:methods; D009126:Muscle Relaxation / Q000187:drug effects / Q000502:physiology; D010865:Pilot Projects; D010880:Piperidines / Q000494:pharmacology*; D010991:Plethysmography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D015742:Propofol / Q000494:pharmacology*; D000077208:Remifentanil; D015656:Respiratory Mechanics / Q000187:drug effects* / Q000502:physiology
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol