Anesthésie et recherche clinique
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How to Manage Upper Airway Patency during Procedural Sedation

Shinji Kurata, Gaku Mishima, Takuro Sanuki, Takao Ayuse

Upper airway obstruction during sedation can result from changes in either the passive structural properties of the pharynx or from disturbances in neuromuscular control. The maintenance of mechanical upper airway properties may significantly contribute to upper airway patency. Therefore, understanding the pathogenesis of upper airway obstruction may help to establish methods of intervention during sedation. This review summarizes recent literature leading understanding of the implications of changes in upper airway patency by mechanical interventions and respiratory management during sedation.

Recently published literature is focusing on the upper airway characteristic under sedation such as propofol, dexmedetomidine, midazolam and ketamine. Furthermore, effective combination of interventions of postural change and airway management with device including nasal high flow seems to have significant benefits for patients with comfort and safe airway management.

It is important to understand the pathophysiology of upper airway obstruction during sedation and to establish effective interventions based on obtained clinical data to achieve the best-personalized sedation method with safer and more stable conditions.