The effects of hormonal status on upper airway patency in normal female subjects during propofol anesthesia
- Resource Type
- Authors
- Masato Kobayashi; Shinji Kurata; Alan R. Schwartz; Susheel P. Patil; Takao Ayuse; Mari Kawai; Yuko Hoshino; Jason P. Kirkness; Hartmut Schneider; Kumiko Oi
- Source
- Journal of Clinical Anesthesia. 23:527-533
- Subject
- Adult
Sedation
media_common.quotation_subject
Luteal Phase
Luteal phase
Hospitals, University
Young Adult
Consciousness Monitors
Follicular phase
medicine
Humans
Prospective Studies
Propofol
Menstrual cycle
media_common
Electromyography
business.industry
Sleep apnea
medicine.disease
Critical closing pressure
Airway Obstruction
Anesthesiology and Pain Medicine
Follicular Phase
Bispectral index
Anesthesia
Female
medicine.symptom
business
Airway
Anesthetics, Intravenous
- Language
- ISSN
- 0952-8180
Study Objective To determine the mechanical upper airway properties and compensatory neuromuscular responses to obstruction during propofol anesthesia in the follicular and luteal phases of the menstrual cycle. Design Prospective, randomized study. Setting University-affiliated hospital. Subjects 12 premenopausal female volunteers for studies of upper airway collapse throughout their menstrual cycle during the follicular phase (6 -10 days) and mid-late luteal phase (20 - 24 days). Measurements The level of propofol anesthesia (1.5 - 2.0 μg/mL) required to suppress arousal responses was determined by Observer's Assessment of Alertness/Sedation scoring (level 2) and confirmed by bispectral index monitoring. Pressure-flow relationships were constructed to evaluate collapsibility (P CRIT ) and up-stream resistance (R US ) during acute [Passive; hypotonic electromyography (EMG)] and sustained (Active; elevated EMG) changes in nasal mask pressure. The difference between passive P CRIT and active P CRIT (ΔP CRIT A-P ) represented the magnitude of the compensatory response to obstruction. Main Results Passive P CRIT was significantly higher in the mid-late luteal phase (-4.7 cm H 2 O) than in the follicular phase (-6.2 cmH 2 O; P CRIT significantly decreased compared with passive P CRIT in the follicular phase (-10.1 cm H 2 O) and in the mid-late luteal phase (-7.7 cm H 2 O) and ( P CRIT between the follicular (3.9 ± 2.9 cm H 2 O) and mid-late luteal phases (3.0 ± 2.6 cm H 2 O). No differences were seen in R US between the menstrual phases for either the passive ( P = 0.8) or active ( P = 0.75) states. Conclusions Menstrual phase has an effect on anatomical alterations (mechanical properties) in the hypotonic upper airway during propofol anesthesia.