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ANESTHETIC PHARMACOLOGY

Bronchial Mucus Transport Velocity in Patients Receiving Propofol and Remifentanil Versus Sevoflurane and Remifentanil Anesthesia

Thomas Ledowski, MD,DEAA^*, Michael J. Paech, DM, FANZCA^*, Bhavesh Patel, MBBS,FRCA^*, and Stephan A. Schug, FANZCA, FFPMANZCA^*

*Department of Anaesthesia and Pain Medicine, Royal Perth Hospital; and School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia

Address correspondence and reprint requests to Thomas Ledowski, MD, DEAA, Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Wellington Street Campus, Perth WA 6000, Australia. Address e-mail to thomas.ledowski{at}health.wa.gov.au.

Volatile anesthetics reduce ciliary beat frequency in vitro. It has been reported that impaired bronchial mucus transport velocity (BTV) is associated with significantly increased pulmonary complications. In this study, we sought to determine in vivo differences in BTV, comparing patients having total IV anesthesia (TIVA) with propofol and remifentanil to anesthesia with sevoflurane and remifentanil. Twenty-two patients scheduled for elective general surgery were randomized to one of two groups: TIVA (propofol/remifentanil) or SEVO (sevoflurane/remifentanil). Thirty minutes after tracheal intubation, BTV was assessed by fiberoptic observation of the movement of methylene blue dye applied to the dorsal surface of the right main bronchus. BTV was significantly reduced in the SEVO group compared with the TIVA group (mean, 1.5 ± 0.7 [0–2.3] versus 4.8 ± 2.1 [2.3–8.8] mm/min; P < 0.0001). Anesthesia with sevoflurane may lead to significantly impaired bronchociliary clearance in comparison to TIVA. This could have implications for perioperative pulmonary complications, in particular in patients at risk for pulmonary complications.