Journal of Applied Physiology
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J Appl Physiol 92: 1987-1994, 2002. First published January 18, 2002; doi:10.1152/japplphysiol.00619.2001
8750-7587/02 $5.00
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Vol. 92, Issue 5, 1987-1994, May 2002

Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children

Karen A. Waters1,4,5, Fergus McBrien1, Penny Stewart2, Murray Hinder3, and Sally Wharton2

Departments of 1 Sleep Medicine, 2 Anesthetics, and 3 Biomedical Engineering, The Children's Hospital at Westmead, Westmead NSW 2145; and Departments of 4 Medicine and 5 Paediatrics and Child Health, University of Sydney, New South Wales 2006, Australia

To assess effects of anesthesia and opioids, we studied 13 children with obstructive sleep apnea (OSA, age 4.0 ± 2.2 yr, mean ± SD) and 24 age-matched control subjects (5.8 ± 4.0 yr). Apnea indexes of children with OSA were 29.4 ± 18 h-1, median 30 h-1. Under inhalational anesthetic, closing pressure at the mask was 2.2 ± 6.9 vs. -14.7 ± 7.8 cmH2O, OSA vs. control (P < 0.001). After intubation, spontaneous ventilation was 115.5 ± 56.9 vs. 158.7 ± 81.6 ml · kg-1 · min-1, OSA vs. control (P = 0.02), despite elevated PCO2 (49.3 vs. 42.1 Torr, OSA vs. control, P < 0.001). Minute ventilation fell after fentanyl (0.5 µg/kg iv), with central apnea in 6 of 13 OSA cases vs. 1 of 23 control subjects (P < 0.001). Consistent with the finding of reduced spontaneous ventilation, apnea was most likely when end-tidal CO2 exceeded 50 Torr during spontaneous breathing under anesthetic. Thus children with OSA had depressed spontaneous ventilation under anesthesia, and opioids precipitated apnea in almost 50% of children with OSA who were intubated but breathing spontaneously under inhalational anesthesia.

closing pressure; analgesia; obstructive sleep apnea


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