Can a difference in chest wall mechanics explain the lower respiratory drive during propofol versus halothane anesthesia in children?

Abstract

This article extends previous work which suggested that respiratory drive was lower during propofol compared with halothane anesthesia. The aim of this study was to assess simultaneously chest wall motion, measured with respiratory inductive plethysmography (RIP), and respiratory drive measured by P0.1 the pressure generated during the initial 100 msec of an occluded inspiratory effort. Ten healthy children age 3 to 6 years who presented for a dental restorative procedure that required in excess of 2.5 hours were recruited. Patients were anesthetized with propofol (2.5 mg · kg-1; 15 mg · kg-1 · hr) or halothane (1.25%), in a randomized crossover study design. Following induction of anesthesia, RIP bands were placed at the level of the nipples and the umbilicus for the measurement of rib cage and abdomen excursion, respectively. Flow and airway pressure were measured. A manually operated pneumatic balloon was used for brief airway occlusion. Following a 60-minute washin/out of the anesthetic, the children were removed from mechanical ventilation and spontaneous ventilation was reinstated. The RIP signals were calibrated by the method of simultaneous solution of equations. The phase lag was calculated. During airway occlusion the maximal excursion of the calibrated rib cage trace (R(MAX)) was measured; a negative value indicated retraction of the rib cage. Respiratory drive was assessed both at a fixed interval (100 msec) (P0.1) and fixed proportion (10%) (P(10%)) of the occluded inspiratory effort. Significance of differences were assessed with a paired t-test (P-value < 0.05). Thoracoabdominal asynchrony was greater during halothane than propofol anesthesia, as was the amount of rib cage retraction, evidenced by lower values of R(MAX); respiratory drive was higher during halothane than propofol anesthesia, as evidenced by higher values of both P0.1 and P(10%). We conclude that during halothane anesthesia altered chest wall mechanics may result in a greater respiratory drive than during propofol anesthesia.