The effects of hormonal status on upper airway patency in normal female subjects during propofol anesthesia

Yuko Hoshino, Takao Ayuse, Masato Kobayashi, Shinji Kurata, Mari Kawai, Hartmut Schneider, Susheel P. Patil, Alan R. Schwartz, Jason P. Kirkness, Kumiko Oi

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Study Objective: To determine the mechanical upper airway properties and compensatory neuromuscular responses to obstruction during propofol anesthesia in the follicular and luteal phases of the menstrual cycle. Design: Prospective, randomized study. Setting: University-affiliated hospital. Subjects: 12 premenopausal female volunteers for studies of upper airway collapse throughout their menstrual cycle during the follicular phase (6 -10 days) and mid-late luteal phase (20 - 24 days). Measurements: The level of propofol anesthesia (1.5 - 2.0 μg/mL) required to suppress arousal responses was determined by Observer's Assessment of Alertness/Sedation scoring (level 2) and confirmed by bispectral index monitoring. Pressure-flow relationships were constructed to evaluate collapsibility (P CRIT) and up-stream resistance (R US) during acute [Passive; hypotonic electromyography (EMG)] and sustained (Active; elevated EMG) changes in nasal mask pressure. The difference between passive P CRIT and active P CRIT (ΔP CRIT A-P) represented the magnitude of the compensatory response to obstruction. Main Results: Passive P CRIT was significantly higher in the mid-late luteal phase (-4.7 cm H 2O) than in the follicular phase (-6.2 cmH 2O; P < 0.05). Active P CRIT significantly decreased compared with passive P CRIT in the follicular phase (-10.1 cm H 2O) and in the mid-late luteal phase (-7.7 cm H 2O) and (P < 0.05). No significant difference was noted in ΔP CRIT between the follicular (3.9 ± 2.9 cm H 2O) and mid-late luteal phases (3.0 ± 2.6 cm H 2O). No differences were seen in R US between the menstrual phases for either the passive (P = 0.8) or active (P = 0.75) states. Conclusions: Menstrual phase has an effect on anatomical alterations (mechanical properties) in the hypotonic upper airway during propofol anesthesia.

Original languageEnglish (US)
Pages (from-to)527-533
Number of pages7
JournalJournal of Clinical Anesthesia
Issue number7
StatePublished - Nov 2011


  • Anesthesia
  • Critical closing pressure
  • Female sex hormones
  • Menstrual cycle
  • Sleep apnea
  • Upper airway patency

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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