Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?

Abstract

Study objective: The risk of airway collapse in patients undergoing deep sedation is a major concern. In this study, we compared the airway patency of deep sedation provided by propofol with the airway patency of deep sedation provided by dexmedetomidine in magnetic resonance imaging (MRI) procedures. This comparison was done using MRI static and dynamic images and comparing these images to baseline after sevoflurane induction.

Design: After institutional review board approval, children who were scheduled for MRI procedures were given an inhalation induction, had intravenous access established, and were randomized to receive either dexmedetomidine 1-μg/kg load followed by 1-μg/(kg h) infusion or propofol infusion at 300 μg/(kg min) reduced to 250-μg/(kg min) infusion. MR images were then obtained. Airway patency and collapse were assessed at the level of the posterior midtongue in the axial and sagittal planes. The degree of airway collapse was assessed by determining the percent change in the airway caliber from its minimum to maximum value. After conclusion of the MRI procedure, the study patients were immediately observed by a blinded observer to determine their level of sedation according to the Ramsey sedation scale.

Setting: MRI scanner at Women and Children's Hospital of Buffalo.

Patients: Forty children between the ages of 3 and 7 years.

Intervention: Comparison of the utilization of propofol against dexmedetomidine infusions for deep sedation to determine the degree of airway collapse.

Measurements: Magnetic resonance images were then obtained using a 1.5-T GE Excite 12.0 scanner. Airway patency and collapse were assessed at the level of the posterior midtongue in the axial and sagittal planes. The degree of airway collapse was assessed by determining the percent change in the airway caliber from its minimum to maximum value. After conclusion of the MRI procedure, the study patients were immediately observed by a blinded observer to determine their level of sedation according to the Ramsey sedation scale.

Main results: Our study demonstrated no difference in airway collapse between dexmedetomidine-based deep sedation and propofol-based deep sedation following sevoflurane induction.

Conclusion: In deep sedation, which is commonly associated with a loss of airway tone, it may not matter which of these intravenous study agents are used. Intravenous sedation with propofol or dexmedetomidine appears to produce the same effect on the pediatric airway.

Keywords: Airway collapse; Airway patency; Dexmedetomidine; MRI sedation; Pediatric sedation; Propofol.