Featured Research

from universities, journals, and other organizations

New anesthesia technique helps show cause of obstruction in sleep apnea

Date:
July 29, 2014
Source:
Wolters Kluwer Health: Lippincott Williams and Wilkins
Summary:
A simplified anesthesia procedure may enable more widespread use of preoperative testing to demonstrate the cause of airway obstruction in patients with severe sleep apnea, suggests a study. Researchers have developed a new "ramp control" anesthetic technique for putting patients to sleep briefly-just enough to show the "obstructive anatomy" responsible for sleep apnea. The simplified technique requires no special expertise and limits drops in blood oxygen level during testing.

A simplified anesthesia procedure may enable more widespread use of preoperative testing to demonstrate the cause of airway obstruction in patients with severe sleep apnea, suggests a study in Anesthesia & Analgesia.

Dr. Joshua H. Atkins and Dr. Jeff E. Mandel of the University of Pennsylvania and their colleagues have developed a new "ramp control" anesthetic technique for putting patients to sleep briefly-just enough to show the "obstructive anatomy" responsible for sleep apnea. The simplified technique requires no special expertise and limits drops in blood oxygen level during testing.

Simplified Approach to Testing Before Apnea Surgery

The researchers evaluated their anesthetic technique in 97 patients participating in a study of robot-assisted surgery for severe sleep apnea. Visualizing the site of the obstruction in the upper airway is an important part of planning for apnea surgery. This can be done using a procedure called "drug-induced sleep endoscopy" (DISE), in which stepwise doses of anesthetic doses are given to put the patient to sleep and reproduce the airway obstruction causing apnea.

However, it's challenging to achieve just the right anesthetic dosage -- enough to cause typical sleep-related obstruction without causing prolonged unconsciousness or causing a deep drop in blood oxygen level (oxygen saturation). The standard technique for DISE is time-consuming and not well-suited for widespread clinical use.

In the new ramp control approach, a computerized algorithm is used to calculate the two-dose sequence of anesthetic administration likely to produce sedation in each individual patient. By contrast, the standard stepwise approach to DISE uses a sequence of up to nine doses.

The 97 patients studied had severe sleep apnea, with a median of 48 apnea-hypopnea events (complete or partial interruptions of breathing) per hour on standard testing in the sleep laboratory. The patients were being evaluated for surgery after receiving no benefit from continuous positive airway pressure (CPAP), the standard treatment for sleep apnea.

The ramp-control DISE approach allowed doctors to see and photograph the obstructive anatomy in all 97 patients. The median time to put the patient to sleep and demonstrate the cause of obstruction was just under four minutes.

Just as important, the necessary level of sedation was achieved without an undue drop in oxygen saturation levels. The median lowest oxygen saturation level during DISE was about 91 percent, compared to an 81 percent value recorded in standard sleep studies. (Normal oxygen saturation is between 95 and 100 percent.)

Two-Dose Technique May Promote Wider Use of DISE

Although it's not new, DISE is still considered a "niche procedure" -- not commonly performed by most anesthesiologists. It's easy to "overshoot" the anesthetic dose; this may lead to drops in oxygen saturation, requiring airway support steps to maintain the patient's blood oxygen level. Dr Atkins and colleagues note that their study included a "challenging" population of obese patients with severe sleep apnea, who have often been excluded from studies of other anesthetic techniques for sleep apnea.

The ramp-control DISE technique is efficient, administering just enough anesthetic to produce the desired level of sedation within a few minutes; and safe, with relatively small drops in blood oxygen saturation level. "The effective sedation seen in this study with a low rate of desaturation and infrequent need for airway support is an important result," Dr Atkins and coauthors write.

By simplifying the steps to anesthesia administration, the researchers believe their simplified approach will help to make DISE more widely available for evaluation of patients being considered for sleep apnea surgery. However, more research will be needed to determine how well the new technique can be generalized to everyday clinical practice at busy surgical centers.


Story Source:

The above story is based on materials provided by Wolters Kluwer Health: Lippincott Williams and Wilkins. Note: Materials may be edited for content and length.


Journal Reference:

  1. Joshua H. Atkins, Jeff E. Mandel, Giulia Rosanova. Safety and Efficacy of Drug-Induced Sleep Endoscopy Using a Probability Ramp Propofol Infusion System in Patients with Severe Obstructive Sleep Apnea. Anesthesia & Analgesia, 2014; 1 DOI: 10.1213/ANE.0000000000000229

Cite This Page:

Wolters Kluwer Health: Lippincott Williams and Wilkins. "New anesthesia technique helps show cause of obstruction in sleep apnea." ScienceDaily. ScienceDaily, 29 July 2014. <www.sciencedaily.com/releases/2014/07/140729092640.htm>.
Wolters Kluwer Health: Lippincott Williams and Wilkins. (2014, July 29). New anesthesia technique helps show cause of obstruction in sleep apnea. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2014/07/140729092640.htm
Wolters Kluwer Health: Lippincott Williams and Wilkins. "New anesthesia technique helps show cause of obstruction in sleep apnea." ScienceDaily. www.sciencedaily.com/releases/2014/07/140729092640.htm (accessed October 22, 2014).

Share This



More Health & Medicine News

Wednesday, October 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

CDC Revamps Ebola Guidelines After Criticism

CDC Revamps Ebola Guidelines After Criticism

Newsy (Oct. 21, 2014) The Centers for Disease Control and Prevention have issued new protocols for healthcare workers interacting with Ebola patients. Video provided by Newsy
Powered by NewsLook.com
WHO: Ebola Vaccine Trials to Start a in January

WHO: Ebola Vaccine Trials to Start a in January

AP (Oct. 21, 2014) Tens of thousands of doses of experimental Ebola vaccines could be available for "real-world" testing in West Africa as soon as January as long as they are deemed safe in soon to start trials, the World Health Organization said Tuesday. (Oct. 21) Video provided by AP
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com
CDC Issues New Ebola Guidelines for Health Workers

CDC Issues New Ebola Guidelines for Health Workers

Reuters - US Online Video (Oct. 21, 2014) The U.S. Centers for Disease Control and Prevention has set up new guidelines for health workers taking care of patients infected with Ebola. Linda So reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins