title: The effects of anesthesia and opioids on the upper airway: A systematic review.
abstract: OBJECTIVE
  Drug-induced sleep endoscopy (DISE) is used to determine surgical therapy for obstructive sleep apnea (OSA); however, the effects of anesthesia on the upper airway are poorly understood. Our aim was to systematically review existing literature on the effects of anesthetic agents on the upper airway.
  
  
  METHODS
  PubMed, CINAHL, EBM reviews and Scopus (all indexed years).
  
  
  METHODS
  Inclusion criteria included English language articles containing original human data. Two investigators independently reviewed all articles for outcomes related to upper airway morphology, dynamics, neuromuscular response, and respiratory control.
  
  
  RESULTS
  The initial search yielded 180 abstracts; 56 articles were ultimately included (total population = 8,540). The anesthetic agents studied were: topical lidocaine, propofol, dexmedetomidine, midazolam, pentobarbital, sevoflurane, desflurane, ketamine, and opioids. Outcome measures were diverse and included imaging studies, genioglossus electromyography, endoscopic airway assessment, polysomnography, upper airway closing pressure, and clinical evidence of obstruction. All agents caused some degrees of airway collapse. Dexmedetomidine did not have dose-dependent effects when evaluated using cine magnetic resonance imaging, unlike sevoflurane, isoflurane, and propofol, and caused less dynamic collapse than propofol.
  
  
  CONCLUSIONS
  Studies assessing the effect of anesthesia on the upper airway in patients with and without OSA are limited, and few compare effects between agents. Medications with minimal effect on respiratory control (e.g., dexmedetomidine) may work best for DISE.
authors.affiliation: Division Pulmonary Medicine.
authors.forename: Zarmina
authors.initials: Z
authors.lastname: Ehsan
authors.affiliation: Division of Anesthesia.|Department of Anesthesiology, University of Cincinnati College of Medicine.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahmoud
authors.affiliation: Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center.|Department of Otolaryngology Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.
authors.forename: Sally R
authors.initials: SR
authors.lastname: Shott
authors.affiliation: Division Pulmonary Medicine.|Department of Otolaryngology Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.
authors.forename: Raouf S
authors.initials: RS
authors.lastname: Amin
authors.affiliation: Division Pulmonary Medicine.|Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center.|Department of Otolaryngology Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
mesh_terms: D000403:Airway Resistance / Q000187:drug effects; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000777:Anesthetics / Q000494:pharmacology*; D006801:Humans; D007830:Larynx / Q000187:drug effects*; D010614:Pharynx / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D000777:Anesthetics
keywords: Anesthesia; adult; children; cine MRI; drug-induced sleep endoscopy; obstructive sleep apnea; opioids; sedation; systematic review; upper airway