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Morphologic changes in the upper airway of children during awakening from propofol administration
Ronald S Litman1, Eric E Weissend, David A Shrier
1Department of Anesthesiology, Division of Pediatric Anesthesia, University of Rochester School of Medicine and Dentistry, New York, USA. litmanr@email.chop.edu
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Children
Area of Science:
- Pediatric airway dynamics
- Anesthesia and respiratory physiology
- Medical imaging in children
Background:
- Propofol sedation is commonly used in children for procedures like MRI.
- Understanding upper airway changes during emergence from sedation is crucial for patient safety.
Purpose of the Study:
- To investigate morphologic changes in the pediatric upper airway during emergence from propofol sedation.
- To compare airway dimensions in sedated versus awake states.
Main Methods:
- 16 children (10 months–7 years) undergoing MRI had upper airway scans during propofol sedation and on awakening.
- Axial views of the pharynx at soft palate and tongue levels were analyzed.
- Measurements included anterior-posterior (A-P) diameter, transverse diameter, and cross-sectional area.
Main Results:
- During sedation, the upper airway was oblong, with A-P diameter often larger than transverse diameter.
- On awakening, the airway shape shifted, with the transverse diameter becoming larger in most children.
- Cross-sectional areas of the pharynx remained largely unchanged between sedated and awake states.
Conclusions:
- Pediatric upper airway shape significantly alters upon awakening from propofol sedation.
- These shape changes may be due to propofol's differential effects on upper airway muscles.
- Awareness of these dynamic changes is important for managing pediatric patients during and after sedation.
Background:
The purpose of this study was to determine the morphologic changes that occur in the upper airway of children during awakening from propofol sedation.
Methods:
Children undergoing magnetic resonance imaging of the head underwent additional scans of the upper airway during deep sedation with propofol; this was repeated on awakening. Axial views were obtained at the most posterior sites of the pharynx at the levels of the soft palate and tongue. Measurements were then obtained of the anterior-posterior (A-P) diameter, transverse diameter, and cross-sectional areas at these levels.
Results:
Data were obtained on 16 children, aged 10 months to 7 yr. In both sedated and awakening states, most children had the smallest cross-sectional area of the pharynx at the level of the soft palate. During the sedated state, at the soft palate level, the transverse diameter was most narrow in 11 children, the A-P diameter was most narrow in 1 child, and they were equal in 2 children. During the sedated state, at the level of the tongue, the transverse diameter was most narrow in 9 children, the A-P diameter was most narrow in 5 children, and they were equal in 2 children. During awakening, at the soft palate level, the transverse diameter was most narrow in none of the children, the A-P diameter was most narrow in 13 children, and they were equal in 1 child. At the level of the tongue, the transverse diameter was most narrow in 4 children, and the A-P diameter was most narrow in 12 children. During awakening, the A-P diameter of the pharynx at the level of the soft palate decreased in 12 children, increased in 1 child, and remained the same in 1 child. (P < 0.001). The transverse diameter increased in 11 children, decreased in 1 child, and remained the same in 2 children (P = 0.001). The cross-sectional area at the level of the soft palate increased in 4 children, decreased in 8 children, and stayed the same in 2 children (P = 0.5). During awakening, the A-P diameter of the pharynx at the level of the tongue decreased in 11 children, increased in 4 children, and remained the same in 1 child. (P = 0.01). The transverse diameter increased in 11 children and decreased in 5 children (P = 0.07). The cross-sectional area at the level of the tongue increased in 7 children, decreased in 7 children, and stayed the same in 2 children (P = 0.9).
Conclusions:
The dimensions of the upper airways of children change shape significantly on awakening from propofol sedation. When sedated, the upper airway is oblong shaped, with the A-P diameter larger than the transverse diameter. On awakening, the shape of the upper airway in most children changed such that the transverse diameter was larger. Cross-sectional areas between sedated and awakening states were unchanged. These changes may reflect the differential effects of propofol on upper airway musculature during awakening.