Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-18T23:28:33.759Z Has data issue: false hasContentIssue false
  • English
  • Français

Bronchial mucus transport velocity in patients receiving desflurane and fentanyl vs. sevoflurane and fentanyl

Published online by Cambridge University Press:  01 September 2008

T. Ledowski ,
A. Manopas  and
S. Lauer
T. Ledowski*
Affiliation:
Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Perth, Western Australia
A. Manopas
Affiliation:
Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Perth, Western Australia
S. Lauer
Affiliation:
Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Perth, Western Australia
*
Correspondence to: Thomas Ledowski, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Wellington Street Campus, Perth WA 6000, Australia. E-mail: thomas.ledowski@health.wa.gov.au; Tel: +61 8 9224 1036; Fax: +61 8 9224 1111
Get access

Summary

Background and objective

Sevoflurane has been shown to distinctly reduce bronchial mucus transport velocity, an essential determinant of mucociliary clearance and pulmonary complications. However, sevoflurane is regarded as one of the least irritant volatile anaesthetics, especially when compared with desflurane. Hence, the aim of this double-blind, randomized, controlled trial was to assess differences in bronchial mucus transport velocity between sevoflurane and desflurane.

Methods

Twenty patients listed for general surgery were randomized to receive either maintenance of anaesthesia with desflurane and fentanyl, or sevoflurane and fentanyl. Thirty minutes after tracheal intubation, bronchial mucus transport velocity was assessed by fibreoptic observation of the movement of methylene blue dye applied to the dorsal surface of the right main bronchus.

Results

Both agents distinctly reduced bronchial mucus transport velocity when compared with previous studies, but the degree of impairment did not significantly differ between the investigated groups (median [25%/75% percentile]): desflurane 1.5 [0.5/4.2] vs. sevoflurane 1.3 [0.3/2.9] mm min−1, P = 0.343).

Conclusions

Desflurane is commonly regarded as more irritant to the airway, but as far as bronchial mucus transport velocity is concerned, the choice between sevoflurane and desflurane does not seem to matter.

Keywords

ANAESTHESIA INHALATIONALDESFLURANESEVOFLURANEMUCUSBRONCHIAL, transport velocity
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 9 , September 2008 , pp. 752 - 755
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Konrad, F, Schreiber, T, Brecht-Kraus, D et al. Mucociliary transport in ICU patients. Chest 1994; 105 (1): 237–241.CrossRefGoogle ScholarPubMed
2.Raphael, JH, Selwyn, DA, Mottram, SD et al. Effects of 3 MAC of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelium in vitro. Br J Anaesth 1996; 76 (1): 116–121.CrossRefGoogle ScholarPubMed
3.Raphael, JH, Strupish, J, Selwyn, DA et al. Recovery of respiratory ciliary function after depression by inhalation anaesthetic agents: an in vitro study using nasal turbinate explants. Br J Anaesth 1996; 76 (6): 854–859.CrossRefGoogle Scholar
4.Raphael, JH, Butt, MW. Comparison of isoflurane with propofol on respiratory cilia. Br J Anaesth 1997; 79 (4): 473–475.CrossRefGoogle ScholarPubMed
5.Ledowski, T, Paech, MJ, Patel, B et al. Bronchial mucus transport velocity in patients receiving propofol and remifentanil versus sevoflurane and remifentanil anesthesia. Anesth Analg 2006; 102 (5): 1427–1430.CrossRefGoogle ScholarPubMed
6.TerRiet, MF, DeSouza, GJ, Jacobs, JS et al. Which is most pungent: isoflurane, sevoflurane or desflurane? Br J Anaesth 2000; 85 (2): 305–307.CrossRefGoogle ScholarPubMed
7.Keller, C, Brimacombe, J. Bronchial mucus transport velocity in paralyzed anesthetized patients: a comparison of the laryngeal mask airway and cuffed tracheal tube. Anesth Analg 1998; 86 (6): 1280–1282.Google ScholarPubMed
8.Sackner, MA, Rosen, MJ, Wanner, A. Estimation of tracheal mucous velocity by bronchofiberscopy. J Appl Physiol 1973; 34 (4): 495–499.CrossRefGoogle ScholarPubMed
9.Wanner, A, Salathe, M, O’Riordan, TG. Mucociliary clearance in the airways. Am J Respir Crit Care Med 1996; 154 (6 Pt 1): 1868–1902.CrossRefGoogle ScholarPubMed
10.Knowles, MR, Boucher, RC. Mucus clearance as a primary innate defense mechanism for mammalian airways. J Clin Invest 2002; 109 (5): 571–577.CrossRefGoogle ScholarPubMed
11.Konrad, FX, Schreiber, T, Brecht-Kraus, D et al. Bronchial mucus transport in chronic smokers and nonsmokers during general anesthesia. J Clin Anesth 1993; 5 (5): 375–380.CrossRefGoogle ScholarPubMed
12.Arain, SR, Shankar, H, Ebert, TJ. Desflurane enhances reactivity during the use of the laryngeal mask airway. Anesthesiology 2005; 103 (3): 495–499.CrossRefGoogle ScholarPubMed
13.Klock, PA Jr, Czeslick, EG, Klafta, JM et al. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology 2001; 94 (6): 963–967.CrossRefGoogle ScholarPubMed
14.Cervin, A, Lindberg, S. Changes in mucociliary activity may be used to investigate the airway-irritating potency of volatile anaesthetics. Br J Anaesth 1998; 80 (4): 475–480.CrossRefGoogle ScholarPubMed
15.Ledowski, T, Hilmi, S, Paech, MJ. Bronchial mucus transport velocity in patients receiving anaesthesia with propofol and morphine or propofol and remifentanil. Anaesthesia 2006; 61 (8): 747–751.CrossRefGoogle ScholarPubMed