However, we felt few limitations worth mentioning such as a small sample size, use of nalbuphine altering airway reflexes
and inter-individual variation in clinical assessment of depth of anaesthesia.
Upper airway reflexes
during a combination of propofol and fentanyl anesthesia.
The reason for the significant difference found in Jee, et al, study, may be due to the dose of lidocaine used in IV route (1 mg/kg) which perhaps was not enough to suppress the airway reflexes
Lockey et al (1999) and Hein and Owen (2005) recognise that patients suffering severe trauma may have full stomachs and impaired airway reflexes
, increasing their risk of pulmonary aspiration.
Anesthetists from Europe and South Africa first address anatomy, physiology, airway reflexes
, and equipment, then discuss basic principles and topics like sleep apnea and anesthesia, intubation, airway damage, extubation, and the aspiration problem.
Following the surgical procedure, the anesthesiologist or nurse anesthetist determines that the patient has adequate respiratory effort, muscle strength, level of consciousness, and intact airway reflexes
. Following this assessment, the process of removing the endotracheal tube, called extubation, is begun.
Procedural sedation previously known as conscious sedation is administration of sedative or dissociative agents or narcotic analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function and preserving the protective airway reflexes
. EBUS instrument is expensive and pulmonologist needs non-collapsing patent airway and immobile patient during the procedure with good oxygenation and haemodynamics.
This dose-related effect of propofol on the airway is a result of depression of central respiratory output to upper airway dilator muscles and suppression of the upper airway reflexes
Propofol is an intravenous induction agent that provides rapid induction, abolishes airway reflexes
and has the maximum intrinsic anti-emetic property amongst all induction agents.
Figure 1 Advantages of spinal anaesthesia over opioid based general anaesthesia Advantages of spinal anaesthesia * Reduced: --pain --blood loss --risk of deep vein thrombosis --post-operative nausea and vomiting --ilues --time in post anaesthetic recovery units --drowsiness * Increased patient satisfaction scores * Prolonged time to first postoperative request for analgesia Figure 2 Disadvantages of sedation used during spinal anaesthesia Disadvantages of sedation * Cost * Infusion pump required for continuous infusion * Peaks and troughs in sedation level * Agitation and confusion * Hangover effect * Loss of airway reflexes
* Amnesia * Cardiovascular instability * Time to reverse sedation variable * Longer time in recovery ward Kenneth O'Connor and Nick Pace
A common factor contributing to morbidity or mortality in cases of poisoning or drug overdose is the loss of protective airway reflexes
and subsequent airway obstruction, aspiration or respiratory compromise and even arrest.
Lignocaine has been used for blunting of pressor responses to intubation since a long time,  especially due to its capability to suppress airway reflexes
triggered by tracheal mucosal irritation and its analgesic as well as antiarrhythmic properties.
This is usually associated with a prolonged recovery time and an increased risk of cardiopulmonary depression and impairment of protective airway reflexes
. Others use general anesthesia to perform these procedures.
Propofol is one of the most useful induction drugs for insertion of the cLMA, because of its superior relaxation of the jaw and suppression of airway reflexes
(4,5), although adjuvants may be needed in many cases.
In addition to providing analgesia, opioids also help to suppress airway reflexes