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Articles in PresS, published online ahead of print January 18, 2002
J Appl Physiol, 10.1152/jap.00619.2001
Submitted on June 15, 2001
Accepted on January 16, 2002
1 Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Medicine, The University of Sydney, Sydney, NSW, Australia; Department of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
2 Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
3 Department of Anaesthetics, The Children's Hospital at Westmead, Sydney, NSW, Australia
4 Department of Biomedical Engineering, The Children's Hospital at Westmead, Sydney, NSW, Australia
* To whom correspondence should be addressed. E-mail: kaw{at}mail.med.usyd.edu.au.
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 controls (5.8 ± 4.0 yr). Apnea indices of children with OSA were 29.4 ± 18 hr-1, median 30 hr-1. Under inhalational anesthetic, closing pressure at the mask was 2.2 ± 6.9 cmH2O vs -14.7 ± 7.8 cmH2O, OSA vs controls (p<0.001). After intubation, spontaneous ventilation was 115.5 ± 56.9 vs 158.7 ± 81.6 ml/kg/min, OSA vs controls (p=0.02), despite elevated pCO2 (49.3 vs 42.1 mmHg, OSA vs controls, p<0.001). Minute ventilation fell after fentanyl (0.5 mcg/kg i.v.), with central apnea in 6/13 OSA cases vs 1/23 controls (p<0.001). Consistent with the finding of reduced spontaneous ventilation, apnea was most likely when end-tidal CO2 exceeded 50 mmHg 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.
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