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Related Experiment Videos

Postoperative obstructive apnea.

G Dhonneur1, X Combes, B Leroux

  • 1Department of Anesthesia, University of Paris, Val de Marne, Hopital Henri Mondor, Créteil, France. gillesdhonneur@hmn.ap-hop.paris.fr

Anesthesia and Analgesia
|September 4, 1999
PubMed
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Benzodiazepines like midazolam can cause postoperative airway obstruction by reducing genioglossus muscle activity. Flumazenil reverses this, restoring airway patency and consciousness in patients recovering from anesthesia.

Area of Science:

  • Anesthesiology
  • Respiratory Physiology
  • Sleep Medicine

Background:

  • Postoperative airway obstruction is a significant concern after general anesthesia.
  • Benzodiazepines, such as midazolam, are commonly used for anesthesia induction and can affect pharyngeal muscle tone.
  • Geniohyoid (Gh) and diaphragm (Di) muscle activity are crucial for maintaining upper airway patency.

Purpose of the Study:

  • To investigate the role of geniohyoid muscle electromyography (EMG) in postoperative upper airway obstruction.
  • To determine the effect of benzodiazepines on pharyngeal muscle support during recovery from anesthesia.
  • To assess the efficacy of flumazenil in reversing benzodiazepine-induced airway obstruction.

Main Methods:

  • Electromyography (EMG) of the geniohyoid (Gh) and diaphragm (Di) muscles was recorded in 12 postoperative patients.

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  • Measurements were taken during spontaneous breathing, obstructive apnea, and after Guedel airway insertion.
  • Pharyngeal muscle activity was assessed before and after flumazenil administration.

    • Main Results:

    • Reduced tonic genioglossus muscle activity (E-Gh(MTA)) was associated with postoperative obstructive apnea.
    • Flumazenil administration restored consciousness and improved tonic E-Gh(MTA), leading to upper airway patency.
    • Resolution of apnea required increased tonic and phasic E-Gh(MTA) and diaphragm activity (E-Di(MTA)).

    Conclusions:

    • Tonic pharyngeal muscular support, specifically from the geniohyoid muscle, is critical for maintaining upper airway patency post-anesthesia.
    • Benzodiazepines are a primary cause of postoperative airway obstruction due to their suppressive effect on pharyngeal muscle tone.
    • Flumazenil effectively reverses benzodiazepine-induced airway obstruction by restoring genioglossus muscle activity.