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Early experience with remote pressure sensor respiratory plethysmography monitoring sedation in the MR scanner

Published online by Cambridge University Press:  01 September 2007

D. Caldiroli  and
L. Minati
D. Caldiroli*
Affiliation:
Istituto Nazionale Neurologico Carlo Besta IRCCS, Department of Neuro-Anaesthesiology, Milan, Italy
L. Minati
Affiliation:
Istituto Nazionale Neurologico Carlo Besta IRCCS, Scientific Direction Unit, Milan, Italy
*
Correspondence to: Dario Caldiroli, Department of Neuro-Anaesthesiology, Istituto Nazionale Neurologico Carlo Besta IRCCS, via Celoria, 11 Milano MI I-20133, Italy. E-mail: [email protected]
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Summary

Background and objective

The importance of monitoring the breathing pattern during sedation of children undergoing magnetic resonance scans is indicated in guidelines, but no appropriate magnetic resonance-compatible devices are available. We report preliminary findings from a technique referred to as remote pressure sensor respiratory plethysmography.

Methods

A data acquisition system was developed, enabling measurement of respiratory rate, plethysmogram amplitude, proportion of inspiratory time over cycle time, thoraco–abdominal phase shift and sigh rate. Correlation between plethysmogram amplitude and tidal volume was investigated on adult volunteers. Twenty-seven children undergoing sedation were monitored with remote pressure sensor respiratory plethysmography, in addition to SPO2 and PetCO2. Differences in monitoring parameters were searched for among three groups: patients who received chloral hydrate only (chloral succeeded, CS group), those who received a supplementation of sodium thiopental (chloral failed, CF group), and those who were sedated with sodium thiopental directly (no chloral, NC group). Correlations were searched for among monitoring parameters, and with total dose of thiopental. The long-term behaviour of respiratory rate, proportion of inspiratory time over cycle time and phase shift was studied.

Results

Plethysmogram amplitude was found to correlate linearly with tidal volume (r > 0.92), with a slope varying up to 22%. While 11% of patients did not tolerate the capnometric probe and readings were discontinuous in 26%, all of them tolerated remote pressure sensor respiratory plethysmography belts. Sighs and non-respiratory movements of the torso could be distinguished on remote pressure sensor respiratory plethysmography waveforms. No significant inter-group differences were found in PetCO2, SPO2, respiratory rate and phase shift. Proportion of inspiratory time over cycle time was higher in the NC group when compared to the CS group (0.497 ± 0.03 vs. 0.463 ± 0.008; P = 0.02), the CF group being characterized by intermediate values (0.480 ± 0.008); when compared to the CS group, sigh rate was lower in the CF group (0.04 ± 0.04 vs. 0.14 ± 0.08; P = 0.04) and in the NC group (0.06 ± 0.05 vs. 0.14 ± 0.08, P = 0.03). A positive correlation was found between total dose of thiopental and proportion of inspiratory time over cycle time, with r = 0.4 and P = 0.04. A large baseline variability in phase shift was found. No long-term trends predictive of patient movement could be identified.

Conclusions

Breathing pattern monitoring is feasible through pneumatic devices, which are well tolerated. The resulting correlation with changes in tidal volume can be better when compared to visual inspection. Proportion of inspiratory time over cycle time and sigh rate convey information related to the state of the sedated patient. These results are not specific to the technology employed, and large-scale studies on the clinical usefulness of breathing pattern monitoring are motivated.

Keywords

CHILDMAGNETIC RESONANCE IMAGINGSEDATIONMONITORING INTRAOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 761 - 769
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Committee on Drugs, American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum. Pediatrics 2002; 110: 836–838.CrossRefGoogle Scholar
2. American Society of Anaesthesiologists. Position on Monitored Anaesthesia (approved October 1986); Guidelines for Patient Care in Anaesthesiology (approved October 1967, amended October 1985); Standards for Basic Intra-Operative Monitoring (approved October 1986, amended October 1990); Standards for Post-Anaesthesia Care (approved October 1988, amended October 1990). Park Ridge, IL: American Society of Anaesthesiologists.Google Scholar
3.Krieger, B, Feinerman, D, Zaron, A, Bizousky, F. Continuous non invasive monitoring of respiratory rate in critically ill patients. Chest 1986; 90: 632–634.CrossRefGoogle Scholar
4.Semmes, BJ, Tobin, MJ, Snyder, JV, Grenvik, A. Subjective and objective measurement of tidal volume in critically ill patients. Chest 1985; 87: 577–579.CrossRefGoogle ScholarPubMed
5.Tsui, BC, Wagner, A, Usher, AG, Cave, DA, Tang, C. Combined propofol and remifentanil intravenous anaesthesia for poediatric patients undergoing magnetic resonance imaging. Paediatr Anaesth 2005; 15: 397–401.CrossRefGoogle ScholarPubMed
6.Agnes, NG. Sevoflurane sedation in infants – a fine line between sedation and general anaesthesia. Paediatr Anaesth 2005; 15: 1–2.Google Scholar
7.Mason, KP, Zgleszewski, SE, Dearden, JL et al. . Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg 2006; 103: 57–62.CrossRefGoogle ScholarPubMed
8. Cortellazzi P, Lamperti M, Minati L, Falcone C, Pantaleoni C, Caldiroli D. Sedation of neurologically impaired children undergoing MRI: a sequential approach. Paediatrc Anaesth 2007; Epub ahead of print.CrossRefGoogle Scholar
9.Banovcin, P, Seidenberg, J, von der Hardt, H. Pressure sensor plethysmography: a method for assessment of respiratory motion in children. Eur Respir J 1995; 8: 167–171.CrossRefGoogle ScholarPubMed
10.Tobin, MJ. Breathing pattern analysis. Intensive Care Med 1992; 18: 193–201.CrossRefGoogle ScholarPubMed
11.Litman, RS, Kottra, JA, Gallagher, PR, Ward, DS. Diagnosis of anesthetic-induced upper airway obstruction in children using respiratory inductance plethysmography. J Clin Monit Comput 2002; 17: 279–285.CrossRefGoogle ScholarPubMed
12.Tobin, MJ, Perez, W, Guenther, SM, Lodato, RF, Dantzker, DR. Does rib cage-abdominal paradox signify respiratory muscle fatigue? J Appl Physiol 1987; 63: 851–860.CrossRefGoogle ScholarPubMed
13.Konno, K, Mead, J. Measurement of the separate volume changes of rib cage and abdomen during breathing. J Appl Physiol 1967; 22: 407–422.CrossRefGoogle ScholarPubMed
14.Agostoni, E, Mognoni, P. Deformation of the chest wall during breathing efforts. J Appl Physiol 1966; 21: 1827–1832.CrossRefGoogle ScholarPubMed
15.Mador, MJ. Respiratory muscle fatigue and breathing pattern. Chest 1991; 100: 1430–1435.CrossRefGoogle ScholarPubMed
16.Tobin, MJ. Respiratory monitoring in the intensive care unit. Am Rev Respir Dis 1988; 138: 1625–1642.CrossRefGoogle ScholarPubMed
17.Bellemare, F, Grassino, A. Evaluation of human diaphragm fatigue. J Appl Physiol 1982; 53: 1196–1206.CrossRefGoogle ScholarPubMed
18.Brown, KA, Reich, O, Bates, JH. Ventilatory depression by halothane in infants and children. Can J Anaesth 1995; 42: 588–596.CrossRefGoogle ScholarPubMed
19.Skeie, B, Emhjellen, S, Wickstrom, E, Dodgson, MS, Steen, PA. Antagonism of flunitrazepam-induced sedative effects by flumazenil in patients after surgery under general anaesthesia. A double-blind placebo-controlled investigation of efficacy and safety. Acta Anaesthesiol Scand 1988; 32: 290–294.CrossRefGoogle ScholarPubMed
20.Gaultier, C, Fletcher, ME, Beardsmore, C, England, S, Motoyama, E. Respiratory function measurements in infants: measurement conditions. Working Group of the European Respiratory Society and the American Thoracic Society. Eur Respir J 1995; 8: 1057–1066.CrossRefGoogle Scholar
21.Benchetrit, G. Breathing pattern in humans: diversity and individuality. Respir Physiol 2000; 122: 123–129.CrossRefGoogle ScholarPubMed
22.Strickland, TL, Drummond, GB. Comparison of pattern of breathing with other measures of induction of anaesthesia, using propofol, methohexital, and sevoflurane. Br J Anaesth 2001; 86: 639–644.CrossRefGoogle ScholarPubMed
23.Eastwood, PR, Platt, PR, Shepherd, K, Maddison, K, Hillman, DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 2005; 103: 470–477.CrossRefGoogle ScholarPubMed
24.Goodman, NW, Kestin, IG. Sighs and their effect on the breathing of patients anaesthetized with infusions of propofol. Br J Anaesth 1992; 68: 48–53.CrossRefGoogle ScholarPubMed
25.Patroniti, N, Foti, G, Cortinovis, B et al. . Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology 2002; 96: 788–794.CrossRefGoogle ScholarPubMed