Synchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation-a post hoc analysis of a prospective study.
Nicolas Ponthieu, Sean Coeckelenbergh, Edgard Engelman, Turgay Tuna, Luc Van Obbergh, Luc Barvais
Author Information
Nicolas Ponthieu: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Sean Coeckelenbergh: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. secoecke@ulb.ac.be.
Edgard Engelman: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Turgay Tuna: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Luc Van Obbergh: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Luc Barvais: Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Perioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO[Formula: see text] and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring, [Formula: see text] and Jaw Activity (JAWAC) mandibular movement sensors. A post hoc analysis investigated airway obstruction prediction using a Respiratory Effort Sequential Detection Algorithm (RESDA) based on [Formula: see text] and mandibular movement signals. 21 patients were recruited and 54 episodes of airway obstruction occurred. RESDA detected obstructive apnea [mean ± SD (median)] 29 ± 29 (21) s, p < 0.0001, before [Formula: see text] alone. This prolonged the time between obstructive apnea detection and decrease to 90% oxygen saturation 64 ± 38 (54) versus 38 ± 20 (35) s, p < 0.0001. It predicted airway obstruction with a sensitivity and specificity of 81% and 93%, respectively. The RESDA algorithm, which is based on the combination of capnography with mandibular movement assessment of respiratory effort, can more rapidly alarm anesthetists of airway obstruction during propofol sedation than [Formula: see text] alone. However, [Formula: see text] pulse oximetry, and clinical monitoring are still required.Trial Registry numbers: ClinicalTrial.gov (NCT02909309) https://clinicaltrials.gov/ct2/show/NCT02909309 .
