Chemosensorisch evozierte Atemänderungen während zweier Propofol-induzierter Sedierungsstadien

Zusammenfassung

Hintergrund: Die affektive Valenz eines Riechreizes wird in seiner respiratorischen Antwort kodiert. Unangenehme Gerüche verkürzen im Wach- und Schlafzustand die Dauer der Inspiration des ersten Reizatemzuges. Unter medikamentös induzierter Sedierung ist das bisher nicht untersucht worden.

Material und Methoden: 13 ASA 1/2-Patienten beiderlei Geschlechts wurden unter Überwachung der Vitalfunktionen während „tiefer“ (EEG-basierter Bispektraler Index: BIS≤60) bzw. „moderater“ (BIS>60) Sedierung mit Propofol bei erhaltener Spontanatmung chemosensorisch (H₂S und CO₂) inspirationssynchron über ein Fluss-Olfaktometer gereizt. Die Dauer der In- und Exspiration wurde für 5 Atemzüge vor und für 2 Atemzüge nach der Reizapplikation analysiert.

Ergebnisse: Im Sedierungsstadium BIS≤60 ließen sich nur mit CO₂ respiratorische Reaktionen auslösen. Bei moderater Sedierung ließen sich auch mit H₂S-Reizen Atemänderungen evozieren. Während einer moderaten Sedierung waren die durch eine CO₂-Reizung bzw. durch eine H₂S-Reizung ausgelösten respiratorischen Reaktionen häufiger mit ihrer Inspirationsdauer verlängert als verkürzt.

Schlussfolgerungen: Olfaktorische Reize verändern die Atmung nur während moderater Sedierung, trigeminale Reize evozieren Atemänderungen sowohl während moderater als auch tiefer Propofol-induzierter Sedierung. Im Gegensatz zum Wach- und Schlafzustand verlängert sich während moderater Sedierung bei einer H₂S-Reizung häufig die Inspiration.

Abstract

Background: The affective valence of an olfactory stimulus will be encoded in its respiratory response. Unpleasant odors shorten the inhalation of the first stimulated breaths in wakefulness and sleep. The aim of the present study was to assess the effekt of intravenous anesthetic propofol on the chemosensory evoked changes of breathing pattern.

Material and methods: 13 ASA 1/2 patients got intranasal chemosensory stimuli (H₂S and CO₂) by flow-olfactometer during “deep” (EEG-based bispectral analysis, BIS:≤60) and “moderate” (BIS>60) propofol-induced sedation with preserved spontaneous breathing. The duration of the in- and exhalation was analyzed for 5 breaths before and for 2 breaths after the onset of stimulation.

Results: During deep sedation respiratory reactions were observed only by CO₂ irritation. During moderate sedation respiratory responses were evoked by H₂S stimuli, too. In moderate sedation extensions of the inhalations of the first breath after both the unpleasant pure olfactory H₂S stimuli and the trigeminal stimuli were more frequent than reductions.

Conclusion: Olfactory stimuli change the breathing only during moderate sedation, trigeminal stimuli during deep and moderate propofol-induced sedation. In opposite to both wakefulness and sleep the duration of inhalation is often extended by H₂S-stimuli during moderate sedation.

Schlüsselwörter

Riechen - Atemänderung - Sedierung - Propofol - EEG - affektive Valenz

Key words

smell - breathing pattern - sedation - propofol - EEG - affective valence

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