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Differences between midazolam and propofol sedation on upper airway collapsibility using dynamic negative airway
J Russell Norton1, Denham S Ward, Suzanne Karan
1Department of Anesthesiology, University of Rochester, New York, New York 14642, USA.
Anesthesiology
|May 30, 2006
Summary
Midazolam and propofol sedation showed similar risks for upper airway obstruction (UAO) in healthy adults. Individual responses varied, with females requiring more negative pressure for UAO with midazolam.
Area of Science:
- Anesthesiology
- Respiratory Physiology
Background:
- Upper airway obstruction (UAO) during sedation is a significant clinical concern.
- Comparing sedating agents for UAO risk can optimize drug selection.
- This study investigated UAO potential of midazolam versus propofol.
Purpose of the Study:
- To compare the propensity for upper airway obstruction (UAO) induced by midazolam and propofol infusions.
- To determine the negative airway pressure required to cause UAO at equivalent sedation levels.
Main Methods:
- Healthy subjects received midazolam or propofol infusions to achieve equivalent sedation levels (Bispectral Index 75 +/- 5).
- Ventilation, end-tidal gases, and respiratory inductance plethysmography were monitored.
- Negative airway pressure was applied incrementally via facemask (-3 to -18 cm H2O) to assess UAO.
Main Results:
- No significant difference in the negative pressure causing UAO between midazolam and propofol.
- A wide range of pressures were required to induce UAO, with some subjects showing no UAO at -18 cm H2O.
- Female subjects required significantly more negative pressure for UAO with midazolam compared to males (P=0.02).
Conclusions:
- Midazolam and propofol exhibit similar propensities for causing upper airway obstruction at mild to moderate sedation levels.
- Individual variability in maintaining the upper airway during sedation is substantial.
- Further research is needed to identify factors influencing upper airway maintenance during sedation.
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