Impaired Upper Airway Integrity by Residual Neuromuscular Blockade Increased Airway Collapsibility and Blunted Genioglossus Muscle Activity in Response to Negative Pharyngeal Pressure
Impaired Upper Airway Integrity by Residual Neuromuscular Blockade Increased Airway Collapsibility and Blunted Genioglossus Muscle Activity in Response to Negative Pharyngeal Pressure
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DOI：
10.1097/aln.0b013e31819faa71
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发表时间：
2009-06-01
期刊：
影响因子：
8.8
通讯作者：
Eikermann, Matthias
中科院分区：
文献类型：
--
作者：
Herbstreit, Frank;Peters, Juergen;Eikermann, Matthias
背景：残留的神经肌肉阻滞增加了发生术后并发症的风险。作者假设，最小的神经肌肉阻断（四列[TOF]比0.5-1）增加上呼吸道的可折叠性，并损害上呼吸道扩张肌对咽负压挑战的代偿反应。方法：对15名清醒健康志愿者（n = 15）在TOF = 0.5和0.8[稳态]时、TOF从罗库罗仑诱导的部分神经肌肉阻断恢复到统一状态前、过程中、呼吸时间和肺容量的变化进行测量。测定被动上气道闭合压力（负压降，随机顺序，+2 ~ -30 cm H(2)O）范围)和限流压力阈值。结果：在TOF比率为0.5、0.8和1.0时，上气道闭合压较基线显著增加（负性较低），分别增加54 +/- 4.4%（平均+/- SEM）、37 +/- 4.2%和16 +/- 41%（与基线相比，任何水平的P < 0.01）。在咽部压力为负（-20 cm H(2)O）时，相性颏舌肌活性几乎翻了两番，在TOF比为0.5和0.8时，这种增加分别显著降低了57 +/- 44%和32 +/- 6%（与基线相比P < 0.01）。呼气末肺容量、呼吸速率和潮气量没有变化。结论：轻度神经肌肉阻断明显增加上气道闭合压力，部分损害颏舌肌代偿反应。尽管通气测试值未受影响，但气道塌陷性增加可能使患者易患术后呼吸并发症，特别是在气道挑战期间。
Background: Residual neuromuscular blockade increases the risk to develop postoperative complications. The authors hypothesized that minimal neuromuscular blockade (train-of-four [TOF] ratio 0.5-1) increases upper airway collapsibility and impairs upper airway dilator muscle compensatory responses to negative pharyngeal pressure challenges.Methods: Epiglottic and nasal mask pressures, genioglossus electromyogram, respiratory timing, and changes in lung volume were measured in awake healthy volunteers (n = 15) before, during (TOF = 0.5 and 0.8 [steady state]), and after recovery of TOF to unity from rocuronium-induced partial neuromuscular blockade. Passive upper airway closing pressure (negative pressure drops, random order, range +2 to -30 cm H(2)O) and pressure threshold for flow limitation were determined.Results: Upper airway closing pressure increased (was less negative) significantly from baseline by 54 +/- 4.4% (means +/- SEM), 37 +/- 4.2%, and 16 +/- 41% at TOF ratios of 0.5, 0.8, and 1.0, respectively (P < 0.01 vs. baseline for any level). Phasic genioglossus activity almost quadrupled in response to negative (-20 cm H(2)O) pharyngeal pressure at baseline, and this increase was significantly impaired by 57 +/- 44% and 32 +/- 6% at TOF ratios of 0.5 and 0.8, respectively (P < 0.01 vs. baseline). End-expiratory lung volume, respiratory rate, and tidal volume did not change.Conclusion: Minimal neuromuscular blockade markedly increases upper airway closing pressure, partly fly impairing the genioglossus muscle compensatory response. Increased airway collapsibility despite unaffected values for testing ventilation may predispose patients to postoperative respiratory complications, particularly during airway challenges.