Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children

Author:

Waters Karen A.123,McBrien Fergus1,Stewart Penny4,Hinder Murray5,Wharton Sally4

Affiliation:

1. Departments of Sleep Medicine,

2. Medicine and

3. Paediatrics and Child Health, University of Sydney, New South Wales 2006, Australia

4. Anesthetics, and

5. Biomedical Engineering, The Children's Hospital at Westmead, Westmead NSW 2145; and Departments of

Abstract

To assess effects of anesthesia and opioids, we studied 13 children with obstructive sleep apnea (OSA, age 4.0 ± 2.2 yr, mean ± SD) and 24 age-matched control subjects (5.8 ± 4.0 yr). Apnea indexes of children with OSA were 29.4 ± 18 h−1, median 30 h−1. Under inhalational anesthetic, closing pressure at the mask was 2.2 ± 6.9 vs. −14.7 ± 7.8 cmH2O, OSA vs. control ( P < 0.001). After intubation, spontaneous ventilation was 115.5 ± 56.9 vs. 158.7 ± 81.6 ml · kg−1 · min−1, OSA vs. control ( P = 0.02), despite elevated Pco 2 (49.3 vs. 42.1 Torr, OSA vs. control, P < 0.001). Minute ventilation fell after fentanyl (0.5 μg/kg iv), with central apnea in 6 of 13 OSA cases vs. 1 of 23 control subjects ( P < 0.001). Consistent with the finding of reduced spontaneous ventilation, apnea was most likely when end-tidal CO2 exceeded 50 Torr during spontaneous breathing under anesthetic. Thus children with OSA had depressed spontaneous ventilation under anesthesia, and opioids precipitated apnea in almost 50% of children with OSA who were intubated but breathing spontaneously under inhalational anesthesia.

Publisher

American Physiological Society

Subject

Physiology (medical),Physiology

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