Pressure support ventilation with the ProSeal (R) laryngeal mask airway. A comparison of sevoflurane, isoflurane and propofol

Background and objective: There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal (R) laryngeal mask airway during pressure support ventilation. Methods: Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 29%, isoflurane end-tidal 1.1% or propofol 6 mg kg(-1) h(-1) in oxygen 33% and air. Pressure support ventilation comprised positive end-expiratory pressure set at 5 cmH(2)O, and pressure support set 5 cmH(2)O above positive end-expiratory pressure. Pressure support was initiated when inspiration produced a 2 cmH(2)O reduction in airway pressure. A blinded observer recorded cardiorespiratory variables (heart rate, mean blood pressure, oxygen saturation, air-way occlusion pressure, respiratory rate, expired tidal volume, expired minute volume and end-tidal CO2), adverse events and emergence times. Results: Respiratory rate and minute volume were 10-21% lower, and end-tidal CO2 6-11% higher with the propofol group compared with the sevoflurane or isoflurane groups, but otherwise cardiorespiratory variables were similar among groups. No adverse events occurred in any group. Emergence times were longer with the propofol group compared with the sevoflurane or isoflurane groups (10 vs. 7 vs. 7 min). Conclusion: Lung ventilation is less effective and emergence times are longer with propofol than sevoflurane or isoflurane for maintenance of anaesthesia during pressure support ventilation with the ProSeal (R) laryngeal mask airway. However, these differences are small and of doubtful clinical importance.

A neuro-mechanical model for interpersonal coordination

The present study investigates the coordination between two people oscillating handheld pendulums, with a special emphasis on the influence of the mechanical properties of the effector systems involved. The first part of the study is an experiment in which eight pairs of participants are asked to coordinate the oscillation of their pendulum with the other participant's in an in-phase or antiphase fashion. Two types of pendulums, A and B, having different resonance frequencies (Freq A=0.98 Hz and Freq B=0.64 Hz), were used in different experimental combinations. Results confirm that the preferred frequencies produced by participants while manipulating each pendulum individually were close to the resonance frequencies of the pendulums. In their attempt to synchronize with one another, participants met at common frequencies that were influenced by the mechanical properties of the two pendulums involved. In agreement with previous studies, both the variability of the behavior and the shift in the intended relative phase were found to depend on the task-effector asymmetry, i.e., the difference between the mechanical properties of the effector systems involved. In the second part of the study, we propose a model to account for these results. The model consists of two cross-coupled neuro-mechanical units, each composed of a neural oscillator driving a wrist-pendulum system. Taken individually, each unit reproduced the natural tendency of the participants to freely oscillate a pendulum close to its resonance frequency. When cross-coupled through the vision of the pendulum of the other unit, the two units entrain each other and meet at a common frequency influenced by the mechanical properties of the two pendulums involved. The ability of the proposed model to address the other effects observed as a function of the different conditions of the pendulum and intended mode of coordination is discussed.