Computer-Assisted Quantitative Analysis of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea/Hypopnea Syndrome.

OBJECTIVES: To use computer-assisted quantitative measurements of upper airway changes during drug-induced sleep endoscopy (DISE) and to correlate these parameters with disease severities and physiologic changes in patients with obstructive sleep apnea/hypopnea syndrome (OSA). DESIGN: A retrospective study. SETTING: Tertiary academic medical center. PATIENTS AND METHODS: A total of 170 patients who failed continuous positive airway pressure therapy and then underwent upper airway surgery were enrolled. All patients received polysomnography and DISE preoperatively. We used ImageJ 1.48v to obtain maximal and minimal measurements, including cross-sectional areas and anterior-posterior and lateral diameters at 4 anatomic levels (retropalatal, oropharyngeal, retroglossal, and retroepiglottic) under DISE, and then computed the percentage changes. We analyzed the clinical values of DISE changes by computer-assisted analysis in patients with OSA and any correlations between these changes and polysomnography parameters. RESULTS: The percentage changes of upper airway showed significant collapses at all 4 anatomic levels (all P < .0001). We also found that the changes at retropalatal levels were significantly greater and that retroglossal levels were significantly smaller, while the changes of anterior-posterior diameters at retroglossal levels showed a significant positive association with apnea-hypopnea index and desaturation index. However, there were no statistically significant correlations between upper airway changes and obesity. CONCLUSION: Computer-assisted quantitative analysis could evaluate upper airway changes of OSA in an objective way and may help identify the sites of obstruction during DISE more accurately. Upper airway showed multilevel collapse with independent significant changes in patients with OSA, with the retropalatal and retroglossal levels playing important roles in particular.

The hemodynamic effect of an intravenous antispasmodic on propofol requirements during colonoscopy: A randomized clinical trial.

PURPOSE: Hemodynamic status during induction of anesthesia may modify the amount of propofol needed to induce loss of consciousness (LOC). This study was aimed to evaluate the effect of antispasmodic-induced tachycardia on the concentration of propofol at the effect-site for inducing LOC when deep sedation was executed for colonoscopy. METHODS: One hundred and sixteen adult patients were randomly assigned to receive either 20 mg of the antispasmodic Buscopan intravenously (Buscopan group; n = 58) or normal saline (control group; n = 58) for colonoscopy. After administration of Buscopan, the antispasmodic or normal saline, propofol was given by means of target-controlled infusion to induce LOC. We recorded patient characteristics, hemodynamic profiles, effect-site propofol concentration upon LOC, total propofol dosage for colonoscopy, and colonoscopy outcomes. RESULTS: There were no significant differences in the characteristics between the two groups. Although the patients receiving Buscopan had a higher heart rate than those of the control group (101 ± 15 beats/minute vs. 77 ± 13 beats/minute; p < 0.001), we found no significant difference between two groups in the effect-site propofol concentration for inducing LOC (3.9 ± 0.6 µg/mL vs. 3.8 ± 0.6 µg/mL; p = 0.261) nor total propofol dosage required for colonoscopy (3.2 ± 1.4 mg/kg vs. 3.1 ± 1.1 mg/kg; p = 0.698). Both groups had comparable colonoscopy outcomes, including percentage of patients completing the procedure and total procedure time. CONCLUSION: The hemodynamic responses to intravenous Buscopan neither affected the effect-site propofol concentration needed to induce LOC, nor the total propofol dosage required for colonoscopy in this study. There is no need to modify the dosage of propofol in patients subject to Buscopan premedication in colonoscopy.